Imaizumi Takahiro, Hasegawa Takeshi, Kosugi Takaaki, Nishiwaki Hiroki, Abe Masanori, Hanafusa Norio, Honda Hirokazu, Tsuruya Kazuhiko, Ito Yasuhiko, Kuragano Takahiro
Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan.
Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Sci Rep. 2025 Jan 21;15(1):2689. doi: 10.1038/s41598-025-87456-z.
Preservation of residual kidney function (RKF) is important in patients undergoing peritoneal dialysis (PD). We aimed to examine the association between anemia management and residual urine output using data from a nationwide survey of dialysis patients. After excluding patients with anuria at baseline from the Total cohort of 2,712, 659 of 1,640 patients developed anuria during a median follow-up of 2.5 (interquartile range: 1.5-4.2) years. Urine volume decreased more rapidly as hemoglobin decreased or as the erythropoiesis-stimulating agent (ESA) resistance index (ERI) increased. The hazard ratios with 95% confidence intervals for the development of anuria, defined as residual urine volume ≤ 100 mL/day, were 1.65 (1.20-2.27), 1.39 (1.08-1.77), and 1.32 (1.07-1.63) for hemoglobin levels of < 9.0, 9.0-9.9, and 10.0-10.9 g/dL compared with 11.0-11.9 g/dL, and 1.35 (1.10-1.66) and 1.41 (1.14-1.73) for the second and third tertiles of ERI compared with the first tertile. In conclusion, patients with a low hemoglobin level or a high ERI were more likely to experience a decline in residual urine output and to develop anuria. Further studies are needed to investigate the effects of interventions that could improve renal anemia and/or ESA hyporesponsiveness on RKF preservation.
对于接受腹膜透析（PD）的患者而言，保留残余肾功能（RKF）至关重要。我们旨在利用一项针对透析患者的全国性调查数据，研究贫血管理与残余尿量之间的关联。在2712名总队列患者中，排除基线时无尿的患者后，1640名患者中有659名在中位随访2.5年（四分位间距：1.5 - 4.2年）期间出现无尿。随着血红蛋白降低或促红细胞生成素（ESA）抵抗指数（ERI）升高，尿量下降更快。对于定义为残余尿量≤100 mL/天的无尿发生情况，血红蛋白水平<9.0、9.0 - 9.9、10.0 - 10.9 g/dL与11.0 - 11.9 g/dL相比，其95%置信区间的风险比分别为1.65（1.20 - 2.27）、1.39（1.08 - 1.77）和1.32（1.07 - 1.63）；ERI的第二和第三三分位数与第一三分位数相比，风险比分别为1.35（1.10 - 1.66）和1.41（1.14 - 1.73）。总之，血红蛋白水平低或ERI高的患者更有可能出现残余尿量下降并发展为无尿。需要进一步研究以调查可改善肾性贫血和/或ESA低反应性的干预措施对保留RKF的影响。
