Renal Section, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA; Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA.
Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Kidney Int. 2019 Sep;96(3):750-760. doi: 10.1016/j.kint.2019.04.029. Epub 2019 May 15.
Iron parameters have not been well characterized in pre-dialysis patients with chronic kidney disease (CKD), and it remains unclear if abnormal iron balance is associated with increased mortality. Therefore, we performed a historical cohort study using data from the Veterans Affairs Corporate Data Warehouse to evaluate the relationship between iron status and mortality. We identified a pre-dialysis CKD cohort with at least one set of iron indices between 2006-2015. The cohort was divided into four iron groups based on the joint quartiles of serum transferrin saturation (percent) and ferritin concentration (ng/ml): reference (16-28%, 55-205 ng/ml), low iron (0.4-16%, 0.4-55 ng/ml), high iron (28-99.6%, 205-4941 ng/ml), and function iron deficiency (0.8-16%, 109-2783 ng/ml). We compared mortality risk between the iron groups using matching weights based on multinomial propensity score models and Poisson rate-based regression. We also evaluated if the association between iron groups and mortality differs between the diabetic and non-diabetic subgroups. Of the 80,067 eligible veterans, 32,489 were successfully matched. During the mean follow-up period of 4.0 years, adjusted relative rate (95% confidence interval) for all-cause mortality in three abnormal iron groups were increased compared to the reference: functional iron deficiency [1.21 (1.17, 1.25)], low iron [1.10 (1.07, 1.14)], and high iron [1.09 (1.06, 1.13)]. The mortality risk was similar between diabetic and non-diabetic subgroups for each iron group. Thus, an abnormal iron balance, particularly functional iron deficiency, is associated with increased mortality in CKD.
在患有慢性肾脏病（CKD）的透析前患者中，铁参数尚未得到很好的描述，目前尚不清楚异常的铁平衡是否与死亡率增加有关。因此，我们使用退伍军人事务部公司数据仓库中的数据进行了一项历史队列研究，以评估铁状态与死亡率之间的关系。我们确定了一个在 2006-2015 年间至少有一套铁指标的透析前 CKD 队列。该队列根据血清转铁蛋白饱和度（%）和铁蛋白浓度（ng/ml）的联合四分位数分为四组铁状态：参考组（16-28%，55-205ng/ml）、低铁组（0.4-16%，0.4-55ng/ml）、高铁组（28-99.6%，205-4941ng/ml）和功能缺铁组（0.8-16%，109-2783ng/ml）。我们使用基于多项倾向得分模型和泊松率回归的匹配权重比较了各组之间的死亡率风险。我们还评估了铁状态与死亡率之间的关联在糖尿病和非糖尿病亚组之间是否不同。在 80067 名合格的退伍军人中，有 32489 人成功匹配。在平均 4.0 年的随访期间，与参考组相比，三个异常铁组的全因死亡率的调整相对风险（95%置信区间）均升高：功能缺铁组[1.21（1.17，1.25）]、低铁组[1.10（1.07，1.14）]和高铁组[1.09（1.06，1.13）]。每个铁组在糖尿病和非糖尿病亚组之间的死亡率风险相似。因此，异常的铁平衡，特别是功能缺铁，与 CKD 患者的死亡率增加有关。
