Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Nephrol Dial Transplant. 2021 Aug 27;36(9):1694-1703. doi: 10.1093/ndt/gfab050.
Iron deficiency (ID) is a common condition in nondialysis-dependent chronic kidney disease (NDD-CKD) patients that is associated with poorer clinical outcomes. However, the effect of ID on health-related quality of life (HRQoL) in this population is unknown. We analyzed data from a multinational cohort of NDD-CKD Stages 3-5 patients to test the association between transferrin saturation (TSAT) index and ferritin with HRQoL.
Patients from Brazil (n = 205), France (n = 2015) and the USA (n = 293) in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps, 2013-2019) were included. We evaluated the association of TSAT and ferritin (and functional and absolute ID, defined as TSAT ≤20% and ferritin ≥300 or <50 ng/mL) on pre-specified HRQoL measures, including the 36-item Kidney Disease Quality of Life physical component summary (PCS) and mental component summary (MCS) as the primary outcomes. Models were adjusted for confounders including hemoglobin (Hb).
TSAT ≤15% and ferritin <50 ng/mL and ≥300 ng/mL were associated with worse PCS scores, but not with MCS. Patients with composite TSAT ≤20% and ferritin <50 or ≥300 ng/mL had lower functional status and worse PCS scores than those with a TSAT of 20-30% and ferritin 50-299 ng/mL. Patients with a lower TSAT were less likely to perform intense physical activity. Adjustment for Hb only slightly attenuated the observed effects.
Low TSAT levels, as well as both low TSAT with low ferritin and low TSAT with high ferritin, are associated with worse physical HRQoL in NDD-CKD patients, even after accounting for Hb level. Interventional studies of iron therapy on HRQoL among NDD-CKD individuals are needed to confirm these findings.
铁缺乏症（ID）是非透析依赖性慢性肾脏病（NDD-CKD）患者的常见病症，与较差的临床结局相关。然而，这种情况下 ID 对健康相关生活质量（HRQoL）的影响尚不清楚。我们分析了来自多国 NDD-CKD 3-5 期患者队列的资料，以检验转铁蛋白饱和度（TSAT）指数和铁蛋白与 HRQoL 的关系。
慢性肾脏病结局和实践模式研究（CKDopps，2013-2019 年）中纳入了巴西（n=205）、法国（n=2015）和美国（n=293）的患者。我们评估了 TSAT 和铁蛋白（以及功能和绝对 ID，定义为 TSAT≤20%和铁蛋白≥300 或<50ng/mL）与预先指定的 HRQoL 指标的关系，主要结局为 36 项肾脏病生活质量量表（KDQoL）的身体成分综合评分（PCS）和精神成分综合评分（MCS）。模型调整了血红蛋白（Hb）等混杂因素。
TSAT≤15%和铁蛋白<50ng/mL 和≥300ng/mL 与 PCS 评分降低相关，但与 MCS 无关。复合 TSAT≤20%和铁蛋白<50ng/mL 或≥300ng/mL 的患者比 TSAT 为 20-30%和铁蛋白 50-299ng/mL 的患者功能状态较差，PCS 评分更低。TSAT 较低的患者不太可能进行剧烈的体力活动。仅调整 Hb 会稍微减弱观察到的效果。
低 TSAT 水平以及低 TSAT 伴低铁蛋白和低 TSAT 伴高铁蛋白均与 NDD-CKD 患者的身体 HRQoL 较差相关，即使考虑到 Hb 水平也是如此。需要进行 NDD-CKD 个体铁治疗对 HRQoL 的干预研究来证实这些发现。
