Choukroun Gabriel, Baghdadi Yasmine, Rabiéga Pascaline, Cazaubon Elise, Maillet Serge, Frimat Luc, Stengel Bénédicte
CHU d’Amiens-Picardie, service de néphrologie, médecine interne, dialyse, transplantation, 1, rond-point du Professeur Christian Cabrol, 80000 Amiens, France
IQVIA, La Défense, Tour D2, 17 bis, place des Reflets, 92099 La Défense cedex, France
Nephrol Ther. 2024 Oct 1;20(6):553-563. doi: 10.1684/ndt.2024.91.
Iron deficiency (ID) is common in patients with chronic kidney disease (CKD) but remains under-diagnosed and its prognosis poorly documented in the absence of anemia. The aim of the study was to assess the relationship between ID and the risk of major adverse outcomes in patients with CKD.
Using data from the French Chronic Kidney Disease - Renal Epidemiology and Information Network (CKD-REIN) cohort which included and followed over five years, 3,033 patients with CKD stages 2 to 5 CKD, we estimated the prevalence of ID, defined by a ferritin level < 100 μg/L and/or a transferrin saturation < 20%, and associated hazard ratios (HR) of kidney failure with replacement therapy, kidney failure defined by an eGFR < 15 mL/min per 1.73 m2 or initiation of kidney replacement therapy, all-cause mortality, and death or hospitalization for heart failure.
Baseline prevalence of ID in the cohort (66% men; mean age 67 ± 13 years) was 50% (48-52). Mean hemoglobin was 13 ± 1.7 g/dL, and only 31% of patients with ID also had a hemoglobin < 12 g/dL. In 2,803 patients with CKD stages 2-4 at baseline, ID was associated with significant increased risk of kidney failure, and of kidney failure with replacement therapy, with HRs adjusted for confounders and hemoglobin level of 1.22 (1.03-1.45) and 1.57 (1.27-1.94), respectively. Adjusted HRs for all-cause mortality and hospitalization or death for heart failure, were 1.31 (1.04-1.66) and 1.38 (1.07-1.80), respectively.
This study shows that ID is significantly associated with the risk for kidney failure, all-cause mortality, and heart failure, independent of the presence of anemia.
缺铁（ID）在慢性肾脏病（CKD）患者中很常见，但仍未得到充分诊断，且在无贫血的情况下其预后记录不佳。本研究的目的是评估CKD患者中ID与主要不良结局风险之间的关系。
利用法国慢性肾脏病-肾脏流行病学和信息网络（CKD-REIN）队列的数据，该队列纳入并随访了5年以上的3033例2至5期CKD患者，我们估计了ID的患病率，其定义为铁蛋白水平<100μg/L和/或转铁蛋白饱和度<20%，以及与肾衰竭替代治疗、定义为估算肾小球滤过率（eGFR）<15ml/（min·1.73m²）或开始肾脏替代治疗的肾衰竭、全因死亡率以及因心力衰竭死亡或住院相关的风险比（HR）。
该队列（66%为男性；平均年龄67±13岁）的ID基线患病率为50%（48 - 52）。平均血红蛋白为1₃±1.7g/dL，且只有31%的ID患者血红蛋白<12g/dL。在基线时处于2 - 4期CKD的2803例患者中，ID与肾衰竭以及肾衰竭替代治疗的风险显著增加相关，校正混杂因素和血红蛋白水平后的HR分别为1.22（1.03 - 1.45）和1.57（1.27 - 1.94）。全因死亡率以及因心力衰竭住院或死亡的校正HR分别为1.31（1.04 - 1.66）和1.38（1.07 - 1.80）。
本研究表明，ID与肾衰竭、全因死亡率和心力衰竭风险显著相关，与贫血的存在无关。
