Kosugi Takaaki, Hasegawa Takeshi, Imaizumi Takahiro, Nishiwaki Hiroki, Honda Hirokazu, Ito Yasuhiko, Tsuruya Kazuhiko, Abe Masanori, Hanafusa Norio, Kuragano Takahiro
Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan.
Institute of Clinical Epidemiology (iCE), Showa University, Tokyo, Japan; Department of Hygiene, Public Health, and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan; Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan; Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Ren Nutr. 2025 May;35(3):443-453. doi: 10.1053/j.jrn.2025.01.003. Epub 2025 Jan 24.
Anemia is a common complication associated with adverse outcomes in older patients undergoing hemodialysis (HD). They also tend to experience malnutrition, which can affect the course of anemia. We hypothesized that the optimal hemoglobin (Hb) level varies depending on nutritional status in older patients undergoing HD and aimed to investigate the association between Hb levels and mortality according to nutritional status.
This is an observational study utilizing a nationwide Japanese database from 2019 to 2021. This study included 95,771 patients aged ≥75 years undergoing HD thrice a week. The nutritional risk index for Japanese hemodialysis patients (NRI-JH) was calculated. The association between Hb levels and mortality was investigated using Cox regression analysis stratified by NRI-JH. A nonlinear relationship was investigated using restricted cubic spline analysis.
During a median follow-up period of 24 months, 27,611 patients died. In the low-risk NRI-JH group, the risk of all-cause mortality was higher in the Hb categories of <9.0, 9.0-9.9, and ≥13 g/dL compared to the reference Hb category of 10-10.9 g/dL, with the adjusted hazard ratios and 95% confidence intervals of 1.45 (1.32-1.59), 1.15 (1.08-1.22), and 1.18 (1.07-1.29), respectively. In contrast, the impact of Hb levels on mortality was significantly attenuated in the high-risk NRI-JH group, with a mild increased risk in the <9.0 g/dL category (adjusted hazard ratio, 1.07; 95% confidence interval, 1.01-1.15).
Among older patients undergoing HD, the impact of Hb levels on mortality was attenuated in the high-risk NRI-JH group.
贫血是老年血液透析（HD）患者常见的并发症，与不良预后相关。他们还容易出现营养不良，这可能会影响贫血的病程。我们假设老年HD患者的最佳血红蛋白（Hb）水平因营养状况而异，旨在根据营养状况研究Hb水平与死亡率之间的关联。
这是一项利用2019年至2021年日本全国数据库的观察性研究。该研究纳入了95771名年龄≥75岁、每周进行三次HD的患者。计算了日本血液透析患者的营养风险指数（NRI-JH）。使用按NRI-JH分层的Cox回归分析研究Hb水平与死亡率之间的关联。使用受限立方样条分析研究非线性关系。
在中位随访期24个月期间，27611名患者死亡。在低风险NRI-JH组中，与参考Hb类别10-10.9 g/dL相比，Hb类别<9.0、9.0-9.9和≥13 g/dL的全因死亡风险更高，调整后的风险比和95%置信区间分别为1.45（1.32-1.59）、1.15（1.08-1.22）和1.18（1.07-1.29）。相比之下，在高风险NRI-JH组中，Hb水平对死亡率的影响显著减弱，<9.0 g/dL类别中的风险略有增加（调整后的风险比，1.07；95%置信区间，1.01-1.15）。
在老年HD患者中，高风险NRI-JH组中Hb水平对死亡率的影响减弱。
