Nephrology Center, Toranomon Hospital, Tokyo, Japan.
Arbor Research Collaborative for Health, Ann Arbor, Michigan.
J Ren Nutr. 2020 Sep;30(5):404-414. doi: 10.1053/j.jrn.2019.11.003. Epub 2020 Jan 21.
Conflicting findings and knowledge gaps exist regarding links between anemia, physical activity, health-related quality of life (HRQOL), chronic kidney disease (CKD) progression, and mortality in moderate-to-advanced CKD. Using the CKD Outcomes and Practice Patterns Study, we report associations of hemoglobin (Hgb) with HRQOL and physical activity, and associations of Hgb and physical activity with CKD progression and mortality in stage 3-5 nondialysis (ND)-CKD patients.
Prospectively collected data were analyzed from 2,121 ND-CKD stage 3-5 patients, aged ≥18 years, at 43 nephrologist-run US and Brazil CKD Outcomes and Practice Patterns Study-participating clinics. Cross-sectional associations were assessed of Hgb levels with HRQOL and physical activity levels (from validated Kidney Disease Quality of Life Instrument and Rapid Assessment of Physical Activity surveys). CKD progression (first of ≥40% estimated glomerular filtration rate [eGFR] decline, eGFR<10 mL/min/1.73 m, or end-stage kidney disease) and all-cause mortality with Hgb and physical activity levels were also evaluated. Linear, logistic, and Cox regression analyses were adjusted for country, demographics, smoking, eGFR, serum albumin, very high proteinuria, and 13 comorbidities.
HRQOL was worse, with severe anemia (Hgb<10 g/dL), but also evident for mild/moderate anemia (Hgb 10-12 g/dL), relative to Hgb>12 g/dL. Odds of being highly physically active were substantially greater at Hgb>10.5 g/dL. Lower Hgb was strongly associated with greater CKD progression and mortality, even after extensive adjustment. Physical inactivity was strongly associated with greater mortality and weakly associated with CKD progression. Possible residual confounding is a limitation.
This multicenter international study provides real-world observational evidence for greater HRQOL, physical activity, lower CKD progression, and greater survival in ND-CKD patients with Hgb levels >12 g/dL, exceeding current treatment guideline recommendations. These findings help inform future studies aimed at understanding the impact of new anemia therapies and physical activity regimens on improving particular dimensions of ND-CKD patient well-being and clinical outcomes.
关于贫血、体力活动、健康相关生活质量（HRQOL）、慢性肾脏病（CKD）进展和中重度 CKD 患者死亡率之间的关联，目前存在相互矛盾的发现和知识差距。利用 CKD 结局和实践模式研究，我们报告了血红蛋白（Hgb）与 HRQOL 和体力活动的关联，以及 Hgb 和体力活动与 3-5 期非透析（ND）-CKD 患者 CKD 进展和死亡率的关联。
对来自美国和巴西的 43 家肾病医生管理的 CKD 结局和实践模式研究参与诊所的 2121 名年龄≥18 岁的 ND-CKD 3-5 期患者的前瞻性收集数据进行了分析。评估了 Hgb 水平与 HRQOL 和体力活动水平（来自经过验证的肾脏病生活质量量表和快速体力活动评估调查）的横断面关联。还评估了 Hgb 和体力活动水平与 CKD 进展（首次估计肾小球滤过率[eGFR]下降≥40%，eGFR<10mL/min/1.73m 或终末期肾病）和全因死亡率的关系。线性、逻辑和 Cox 回归分析调整了国家、人口统计学、吸烟、eGFR、血清白蛋白、大量蛋白尿和 13 种合并症。
HRQOL 更差，与严重贫血（Hgb<10g/dL）有关，但与轻度/中度贫血（Hgb 10-12g/dL）也有关，与 Hgb>12g/dL 相比。Hgb>10.5g/dL 时，高度体力活动的可能性明显更大。较低的 Hgb 与更大的 CKD 进展和死亡率密切相关，即使在广泛调整后也是如此。体力活动不足与死亡率增加密切相关，与 CKD 进展微弱相关。可能存在残余混杂是一个限制。
这项多中心国际研究提供了真实世界的观察证据，表明在 Hgb 水平>12g/dL 的 ND-CKD 患者中，HRQOL 更高、体力活动更多、CKD 进展更低、生存率更高，超过了当前治疗指南的建议。这些发现有助于为未来旨在了解新型贫血治疗和体力活动方案对改善 ND-CKD 患者特定方面的健康和临床结局的影响的研究提供信息。
