■非透析依赖性(NDD)慢性肾脏病(CKD)贫血患者治疗开始时血红蛋白水平与肾脏和心血管预后的关系尚不清楚。
■这项回顾性队列研究利用了2个日本数据库(MedicalDataVisionCo.Ltd.,东京,日本[MDV];和真实世界数据有限公司,京都,日本[RWD])。开始使用长效红细胞生成刺激剂(ESA)治疗的患者分为早期(血红蛋白水平≥9.0g/dl)和延迟(<9.0g/dl)治疗组。主要结果是肾脏复合(肾脏替代疗法,估计肾小球滤过率[eGFR]降低≥50%,eGFR<6.0ml/min/1.73m2,以及全因死亡率),和次要结局是心血管复合(缺血性心脏病住院,包括心肌梗塞,因中风和心力衰竭住院,和心血管死亡)和复合结局的组成部分。
■倾向得分匹配后,对1472例(MDV)和1264例(RWD)患者进行了评估。延迟治疗与肾脏综合结局的风险无关(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,延迟治疗与心血管综合结局的高风险相关(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)。
■尽管NDD-CKD患者延迟治疗贫血后肾脏事件的风险没有增加,心血管事件和全因死亡率的风险增加,提示在血红蛋白低于9.0g/dl之前进行早期干预的重要性。
UNASSIGNED: 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.
UNASSIGNED: 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 m2, 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.
UNASSIGNED: 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).
UNASSIGNED: 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.