Zhu Yongjian, Liu Xiaozhuan, Li Ning, Cui Lingling, Zhang Xiaofeng, Liu Xinxin, Yu Kailun, Chen Yao, Wan Zhongxiao, Yu Zengli
School of Public Health, Zhengzhou University, Zhengzhou, China.
College of Food Science and Technology, Henan Agriculture University, Zhengzhou, China.
Front Med (Lausanne). 2020 Jan 8;6:303. doi: 10.3389/fmed.2019.00303. eCollection 2019.
Even though it is well-known that iron deficiency is the result of chronic kidney disease (CKD), whether iron will affect kidney function and disease in the general population is not clear. We thus conducted a nationwide cross-sectional study using data from the China Health and Nutrition Survey (CHNS) to assess the relationship of iron status with estimated glomerular filtration rate (eGFR) and CKD among general adults. A total of 8,339 adults from the China Health and Nutrition Survey in the wave of 2009 were included to assess the association between iron status and eGFR/CKD. Serum ferritin (SF), transferrin, soluble transferrin receptor (sTfR), and hemoglobin (Hb) were measured. The relationship of iron status and eGFR was evaluated by using multi-variable linear regression model. The effect of iron status on the odds of CKD was calculated by logistic regression model. For the association between iron status and eGFR, every 100 μg/L increase in SF was correlated with 0.26 ml/min per 1.73 m (95% CI: 0.08-0.44) decrease in eGFR, and every 5 mg/L increase in sTfR was associated with a decrease of 6.00 ml/min per 1.73 m (95% CI: 3.79-8.21) in eGFR. There were no significant associations between Hb or transferrin with eGFR. For the association between iron status and CKD, every 5 g/L increase in sTfR was associated with an odds ratio of 3.72 (95% CI: 2.16-6.13) for CKD. The concentrations of Hb were associated with the odds of CKD in a U-shaped manner, with the lowest risk in the Hb range of 136-141 g/L. There was a positive correlation between SF concentration and CKD prevalence but not in a dose-response manner. The odds of CKD for participants in the highest tertile increased by 28% (98% CI: 1-63%) compared with those in the lowest tertile. The concentration of SF and sTfR was positively correlated with the odds of CKD, and Hb was associated with the odds of CKD in a U-shaped manner. Further large prospective researches are warranted to confirm these findings.
尽管众所周知缺铁是慢性肾脏病（CKD）的结果，但铁是否会影响普通人群的肾功能和疾病尚不清楚。因此，我们利用中国健康与营养调查（CHNS）的数据进行了一项全国性横断面研究，以评估普通成年人中铁状态与估计肾小球滤过率（eGFR）和CKD之间的关系。纳入了2009年中国健康与营养调查中的8339名成年人来评估铁状态与eGFR/CKD之间的关联。检测了血清铁蛋白（SF）、转铁蛋白、可溶性转铁蛋白受体（sTfR）和血红蛋白（Hb）。使用多变量线性回归模型评估铁状态与eGFR的关系。通过逻辑回归模型计算铁状态对CKD发生几率的影响。对于铁状态与eGFR之间的关联，SF每增加100μg/L与eGFR每1.73m²降低0.26ml/min（95%CI：0.08 - 0.44）相关，sTfR每增加5mg/L与eGFR每1.73m²降低6.00ml/min（95%CI：3.79 - 8.21）相关。Hb或转铁蛋白与eGFR之间无显著关联。对于铁状态与CKD之间的关联，sTfR每增加5g/L与CKD的比值比为3.72（95%CI：2.16 - 6.13）相关。Hb浓度与CKD发生几率呈U形关联，在Hb范围为136 - 141g/L时风险最低。SF浓度与CKD患病率呈正相关，但不是剂量反应关系。与最低三分位数的参与者相比，最高三分位数的参与者CKD发生几率增加了28%（98%CI：1 - 63%）。SF和sTfR的浓度与CKD发生几率呈正相关，Hb与CKD发生几率呈U形关联。需要进一步的大型前瞻性研究来证实这些发现。
