Kawai Kouji, Ishii Manabu, Kokado Yoshimasa, Horikawa Takashi, Hoshino Junichi
Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan.
Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
Kidney Int Rep. 2024 Apr 15;9(7):2056-2066. doi: 10.1016/j.ekir.2024.04.030. eCollection 2024 Jul.
The association of hemoglobin level at treatment initiation with renal and cardiovascular outcomes in patients with anemia in nondialysis-dependent (NDD) chronic kidney disease (CKD) is unclear.
This retrospective cohort study utilized 2 Japanese databases (Medical Data Vision Co. Ltd., Tokyo, Japan [MDV]; and Real World Data Co. Ltd, Kyoto, Japan [RWD]). Patients initiated on long-acting erythropoiesis-stimulating agent (ESA) treatment were divided into early (hemoglobin levels ≥9.0 g/dl) and delayed (<9.0 g/dl) treatment groups. The primary outcome was a renal composite (renal replacement therapy, ≥50% estimated glomerular filtration rate [eGFR] reduction, eGFR <6.0 ml/min per 1.73 m, and all-cause mortality), and secondary outcomes were a cardiovascular composite (hospitalization by ischemic heart disease, including myocardial infarction, hospitalization by stroke and heart failure, and cardiovascular death) and components of the composite outcomes.
After propensity score matching, 1472 (MDV) and 1264 (RWD) patients were evaluated. Delayed treatment was not associated with a risk of the renal composite outcome (MDV: hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 0.99-1.33; RWD: HR: 1.08, 95% CI: 0.92-1.28). However, delayed treatment was associated with higher risks of the cardiovascular composite outcome (MDV: HR: 1.47, 95% CI: 1.16-1.84; RWD: HR: 1.34, 95% CI: 1.09-1.64), heart failure (MDV: HR: 1.50, 95% CI: 1.13-2.00; RWD: HR: 1.53, 95% CI: 1.20-1.96) and all-cause mortality (MDV: HR: 1.83, 95% CI: 1.32-2.54; RWD: HR: 1.64, 95% CI: 1.21-2.22).
Although the risk of renal events was not increased following delayed treatment of anemia in patients with NDD-CKD, the risks of cardiovascular events and all-cause mortality were increased, suggesting the importance of early intervention before hemoglobin falls below 9.0 g/dl.
在非透析依赖型（NDD）慢性肾脏病（CKD）患者中，起始治疗时血红蛋白水平与肾脏和心血管结局之间的关联尚不清楚。
这项回顾性队列研究利用了2个日本数据库（日本东京医疗数据视觉有限公司[MDV]；以及日本京都真实世界数据有限公司[RWD]）。开始接受长效促红细胞生成素刺激剂（ESA）治疗的患者被分为早期（血红蛋白水平≥9.0 g/dl）和延迟（<9.0 g/dl）治疗组。主要结局是肾脏复合结局（肾脏替代治疗、估计肾小球滤过率[eGFR]降低≥50%、eGFR<6.0 ml/min/1.73 m²以及全因死亡率），次要结局是心血管复合结局（因缺血性心脏病住院，包括心肌梗死、因中风和心力衰竭住院以及心血管死亡）以及复合结局的各个组成部分。
在倾向评分匹配后，对1472例（MDV）和1264例（RWD）患者进行了评估。延迟治疗与肾脏复合结局风险无关（MDV：风险比[HR]：1.15，95%置信区间[CI]：0.99 - 1.33；RWD：HR：1.08，95% CI：0.92 - 1.28）。然而，延迟治疗与心血管复合结局（MDV：HR：1.47，95% CI：1.16 - 1.84；RWD：HR：1.34，95% CI：1.09 - 1.64）、心力衰竭（MDV：HR：1.50，95% CI：1.13 - 2.00；RWD：HR：1.53，95% CI：1.20 - 1.96）和全因死亡率（MDV：HR：1.83，95% CI：1.32 - 2.54；RWD：HR：1.64，95% CI：1.21 - 2.22）的较高风险相关。
尽管NDD-CKD患者贫血延迟治疗后肾脏事件风险未增加，但心血管事件和全因死亡率风险增加，这表明在血红蛋白降至9.0 g/dl以下之前进行早期干预的重要性。
