Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Nam-Gu, Daegu 42415, Republic of Korea.
Health Insurance Review and Assessment Service, 60 Hyeoksin-Ro, Wonju-si 26465, Republic of Korea.
Nutrients. 2023 May 31;15(11):2577. doi: 10.3390/nu15112577.
The aim of this study was to evaluate survival rates according to iron status in patients undergoing maintenance hemodialysis (HD). Thus, the National HD Quality Assessment Program dataset and claims data were used for analysis ( = 42,390). The patients were divided into four groups according to their transferrin saturation rate and serum ferritin levels: Group 1 ( = 34,539, normal iron status); Group 2 ( = 4476, absolute iron deficiency); Group 3 ( = 1719, functional iron deficiency); Group 4 ( = 1656, high iron status). Using univariate and multivariable analyses, Group 1 outperformed the three other groups in terms of patient survival. Using univariate analysis, although Group 2 showed a favorable trend in patient survival rates compared with Groups 3 and 4, the statistical significance was weak. Group 3 exhibited similar patient survival rates to Group 4. Using multivariable Cox regression analysis, Group 2 had similar patient survival rates to Group 3. Subgroup analyses according to sex, diabetic status, hemoglobin level ≥ 10 g/dL, and serum albumin levels ≥ 3.5 g/dL indicated similar trends to those of the total cohort. However, subgroup analysis based on patients with a hemoglobin level < 10 g/dL or serum albumin levels < 3.5 g/dL showed a weak statistical significant difference compared with those with hemoglobin level ≥ 10 g/dL, or serum albumin levels ≥ 3.5 g/dL. In addition, the survival difference between Group 4 and other groups was greater in old patients than in young ones. Patients with a normal iron status had the highest survival rates. Patient survival rates were similar or differed only modestly among the groups with abnormal iron status. In addition, most subgroup analyses revealed similar trends to those according to the total cohort. However, subgroup analyses based on age, hemoglobin, or serum albumin levels showed different trends.
本研究旨在评估接受维持性血液透析（HD）患者的生存率与铁状态的关系。为此，我们使用了国家 HD 质量评估计划数据集和索赔数据进行分析（n=42390）。根据转铁蛋白饱和度和血清铁蛋白水平，患者被分为四组：组 1（n=34539，铁状态正常）；组 2（n=4476，绝对缺铁）；组 3（n=1719，功能性缺铁）；组 4（n=1656，高铁状态）。使用单变量和多变量分析，组 1 在患者生存率方面优于其他三组。使用单变量分析，尽管组 2 的患者生存率较组 3 和组 4 有较好的趋势，但统计学意义较弱。组 3 的患者生存率与组 4 相似。使用多变量 Cox 回归分析，组 2 的患者生存率与组 3 相似。根据性别、糖尿病状态、血红蛋白水平≥10g/dL 和血清白蛋白水平≥3.5g/dL 的亚组分析显示出与总队列相似的趋势。然而，基于血红蛋白水平<10g/dL 或血清白蛋白水平<3.5g/dL 的患者的亚组分析与血红蛋白水平≥10g/dL 或血清白蛋白水平≥3.5g/dL 的患者相比，差异具有统计学意义。此外，与血红蛋白水平≥10g/dL 或血清白蛋白水平≥3.5g/dL 的患者相比，老年患者组 4 与其他组之间的生存差异更大。铁状态正常的患者具有最高的生存率。铁状态异常的各组之间的生存率相似或略有差异。此外，大多数亚组分析显示出与总队列相似的趋势。然而，基于年龄、血红蛋白或血清白蛋白水平的亚组分析显示出不同的趋势。
