Foley R N, Parfrey P S, Harnett J D, Kent G M, Murray D C, Barre P E
Division of Nephrology, The Health Sciences Centre, Memorial Univesity, St. John's, Newfoundland, Canada.
Am J Kidney Dis. 1996 Jul;28(1):53-61. doi: 10.1016/s0272-6386(96)90130-4.
To determine the possible association between anemia and clinical and echocardiographic cardiac disease, a cohort of 432 end-stage renal disease patients (261 on hemodialysis and 171 on peritoneal dialysis) who started dialysis therapy between 1982 and 1991 were followed prospectively for an average of 41 months. Baseline demographic, clinical, and echocardiographic assessments were performed, as well as monthly serial clinical and laboratory tests while the patients were on dialysis therapy. The mean (+/-SD) hemoglobin level during dialysis therapy was 8.8 +/- 1.5 g/dL. After adjusting for age, diabetes, and ischemic heart disease, as well as for blood pressure and serum albumin levels measured serially, each 1 g/dL decrease in mean hemoglobin was independently associated with the presence of left ventricular dilatation on repeat echocardiogram (odds ratio, 1.46; P = 0.018) and the development of de novo (relative risk [RR] = 1.28; P = 0.018) and recurrent (RR = 1.20; P = 0.046) cardiac failure. In addition, each 1 g/dL decrease in the mean hemoglobin level was independently associated with mortality while the patients were on dialysis therapy (RR = 1.14; P = 0.024). Anemia had no independent association with the development of ischemic heart disease while the patients were on dialysis therapy. Anemia, an easily reversible feature of end-stage renal disease, is an independent risk factor for clinical and echocardiographic cardiac disease, as well as mortality in end-stage renal disease patients.
为了确定贫血与临床及超声心动图所示心脏病之间可能存在的关联，我们对一组432例终末期肾病患者进行了前瞻性随访，这些患者于1982年至1991年间开始透析治疗（261例接受血液透析，171例接受腹膜透析），平均随访时间为41个月。进行了基线人口统计学、临床及超声心动图评估，并且在患者接受透析治疗期间每月进行系列临床和实验室检查。透析治疗期间平均血红蛋白水平为8.8±1.5g/dL。在对年龄、糖尿病、缺血性心脏病以及连续测量的血压和血清白蛋白水平进行校正后，平均血红蛋白每降低1g/dL，与重复超声心动图显示的左心室扩张（比值比，1.46；P = 0.018）以及新发（相对危险度[RR]=1.28；P = 0.018）和复发性（RR = 1.20；P = 0.046）心力衰竭的发生独立相关。此外，平均血红蛋白水平每降低1g/dL，与患者透析治疗期间的死亡率独立相关（RR = 1.14；P = 0.024）。在患者接受透析治疗期间，贫血与缺血性心脏病的发生无独立关联。贫血是终末期肾病易于逆转的一个特征，是终末期肾病患者临床及超声心动图所示心脏病以及死亡的一个独立危险因素。
