非透析依赖型慢性肾脏病患者中绝对缺铁性贫血和功能性缺铁性贫血的患病率、相关因素和结局。

Prevalence, correlates and outcomes of absolute and functional iron deficiency anemia in nondialysis-dependent chronic kidney disease.

机构信息

Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

Center for Innovation in Quality Effectiveness & Safety, Michael E. Debakey VA Medican Center, Houston, TX, USA.

出版信息

Nephrol Dial Transplant. 2021 Jan 1;36(1):129-136. doi: 10.1093/ndt/gfz192.

DOI:10.1093/ndt/gfz192

PMID:31641775

Abstract

BACKGROUND

Anemia is associated with adverse outcomes in those with chronic kidney disease (CKD). We examined the association of absolute and functional iron deficiency anemia (IDA) with adverse outcomes (cardiovascular hospitalization, dialysis and mortality) in those with nondialysis-dependent CKD.

METHODS

Nondialysis-dependent CKD patients followed in the US Veterans Administration with hemoglobin level measured within 90 days of the date of the second estimated glomerular filtration rate <60 mL/min/1.73 m2 were included. Logistic regression, multivariate Cox proportional hazards and Poisson regression models adjusted for demographics and comorbidities were used to assess the prevalence and correlates of absolute [transferrin saturation (TSAT) ≤20%, ferritin <100 ng/mL] and functional (TSA T≤20%, ferritin >100-500 ng/mL) IDA and the associations of absolute and functional IDA with mortality, dialysis and cardiovascular hospitalization.

RESULTS

Of 933 463 patients with CKD, 20.6% had anemia. Among those with anemia, 23.6% of patients had both TSAT and ferritin level measured, of whom 30% had absolute IDA and 19% had functional IDA. Absolute IDA in CKD was not associated with an increased risk of mortality or dialysis but was associated with a higher risk of 1-year {risk ratio [RR] 1.20 [95% confidence interval (CI) 1.12-1.28]} and 2-year cardiovascular hospitalization [RR 1.11 (95% CI 1.05-1.17)]. CKD patients with functional IDA had a higher risk of mortality [hazard ratio (HR) 1.11 (95% CI 1.07-1.14)] along with a higher risk of 1-year [RR 1.21 (95% CI 1.1-1.30)] and 2-year cardiovascular hospitalization [RR 1.13 (95% CI 1.07-1.21)]. Ferritin >500 ng/mL (treated as a separate category) was only associated with an increased risk of mortality [HR 1.38 (95% CI 1.26-1.51)].

CONCLUSIONS

In a large population of CKD patients with anemia, absolute and functional IDA were associated with various clinical covariates. Functional IDA was associated with an increased risk of mortality and cardiovascular hospitalization, but absolute IDA was associated only with a higher risk of hospitalization.

摘要

背景

贫血与慢性肾脏病（CKD）患者的不良结局相关。我们研究了非透析依赖型 CKD 患者中绝对和功能性缺铁性贫血（IDA）与不良结局（心血管住院、透析和死亡）的相关性。

方法

纳入在美国退伍军人事务部接受治疗的血红蛋白水平在第二次估计肾小球滤过率<60ml/min/1.73m2 测定后 90 天内测量的非透析依赖型 CKD 患者。使用逻辑回归、多变量 Cox 比例风险和泊松回归模型调整人口统计学和合并症，以评估绝对（转铁蛋白饱和度[TSAT]≤20%，铁蛋白<100ng/ml）和功能性（TSAT≤20%，铁蛋白>100-500ng/ml）IDA 的患病率和相关性，以及绝对和功能性 IDA 与死亡率、透析和心血管住院的相关性。

结果

在 933463 例 CKD 患者中，20.6%患有贫血。在患有贫血的患者中，有 23.6%的患者同时测量了 TSAT 和铁蛋白水平，其中 30%患有绝对 IDA，19%患有功能性 IDA。CKD 中的绝对 IDA 与死亡率或透析风险增加无关，但与 1 年[风险比（RR）1.20（95%置信区间[CI]1.12-1.28）]和 2 年心血管住院[RR 1.11（95%CI 1.05-1.17）]的风险增加相关。功能性 IDA 的 CKD 患者死亡率风险较高[危险比（HR）1.11（95%CI 1.07-1.14）]，且 1 年[RR 1.21（95%CI 1.1-1.30）]和 2 年心血管住院[RR 1.13（95%CI 1.07-1.21）]的风险增加。铁蛋白>500ng/ml（视为单独类别）仅与死亡率增加相关[HR 1.38（95%CI 1.26-1.51）]。