Department of Nephrology, Peking University People's Hospital, Beijing, China,
Department of Nephrology, Peking University People's Hospital, Beijing, China.
Blood Purif. 2024;53(7):583-590. doi: 10.1159/000539080. Epub 2024 May 6.
Disordered iron balance and abnormal parathyroid hormone (PTH) concentrations, both prevalent in hemodialysis patients, are risk factors of erythropoietin (EPO) resistance. Few studies have evaluated the correlation between iron indices and PTH and the potential role of iron markers on the association of PTH with EPO resistance in hemodialysis population.
In this cross-sectional study of 71 maintenance hemodialysis patients, iron indices including hepcidin, ferritin, reticulocyte hemoglobin content (CHr), and transferrin saturation (TSAT) were examined. EPO responsiveness was measured as EPO resistance index (ERI). Lowess regression curves were performed to explore the correlations of iron indices, PTH, and ERI. The association between PTH and ERI was modeled using linear regressions. Potential role of iron indices on this association was examined using stratified analyses and mediation analyses.
The average ERI value was 10.3 ± 5.3 IU w-1 kg-1 (g/dL) -1. ERI was correlated to PTH, hepcidin, CHr, and TSAT (all p < 0.05). Hepcidin and PTH were closely correlated with each other (r = 0.28, p = 0.020). Analysis by PTH categories yielded a total association effect of 2.53 (95% CI: 0.27-4.85, p = 0.027) for high PTH subgroup versus the reference low subgroup. No clinically significant interaction between iron indexes and PTH was identified. Hepcidin appeared to mediate about one-third of the total association between PTH and ERI in hemodialysis population (33.6%, p = 0.025).
Iron indices and PTH levels were related to ERI values. Hepcidin appeared to be closely correlated to PTH and partly mediate the association between PTH and ERI in hemodialysis population.
铁代谢紊乱和甲状旁腺激素（PTH）浓度异常在血液透析患者中很常见，是促红细胞生成素（EPO）抵抗的危险因素。很少有研究评估铁指标与 PTH 之间的相关性，以及铁标志物在血液透析人群中 PTH 与 EPO 抵抗的关联中的潜在作用。
在这项对 71 名维持性血液透析患者的横断面研究中，检查了铁指标，包括铁调素、铁蛋白、网织红细胞血红蛋白含量（CHr）和转铁蛋白饱和度（TSAT）。EPO 反应性用 EPO 抵抗指数（ERI）来衡量。使用低阶回归曲线来探索铁指标、PTH 和 ERI 的相关性。使用线性回归来模拟 PTH 和 ERI 之间的关系。使用分层分析和中介分析来检验铁指标对这种关联的潜在作用。
平均 ERI 值为 10.3 ± 5.3 IU w-1 kg-1（g/dL）-1。ERI 与 PTH、铁调素、CHr 和 TSAT 相关（均 p < 0.05）。铁调素和 PTH 之间存在密切的相关性（r = 0.28，p = 0.020）。按 PTH 分类分析，高 PTH 亚组与低 PTH 参考亚组之间的总关联效应为 2.53（95%CI：0.27-4.85，p = 0.027）。未发现铁指标和 PTH 之间存在有临床意义的相互作用。铁调素似乎介导了血液透析人群中 PTH 和 ERI 之间总关联的约三分之一（33.6%，p = 0.025）。
铁指标和 PTH 水平与 ERI 值相关。铁调素与 PTH 密切相关，部分介导了血液透析人群中 PTH 与 ERI 之间的关联。
