背景:慢性肾脏病(CKD)患者尽管有多种治疗方法,但仍有较高的死亡率和发病率。尽管CKD-矿物质和骨障碍(MBD)和肾性贫血是CKD患者的重要因素,只有少数研究分析了它们之间的关系。因此,本研究旨在评估未接受红细胞生成刺激剂或铁剂治疗的CKD患者中CKD-MBD与贫血之间的关系.
方法:这项回顾性横断面研究包括2018年4月至2019年7月期间转诊至富士市总医院的年龄≥20岁的CKD患者,估计肾小球滤过率(eGFR)为G2a至G5。排除标准是CKD-MBD和/或贫血的持续治疗。
结果:本研究分析了300例CKD患者的数据。患者的中位年龄为71岁(范围,56.5-79)年。eGFR中位数为34(范围,20-48)mL/min/1.73m2,平均血红蛋白(Hb)水平为12.7g/dL(标准偏差,2.3),随着CKD分期的增加而降低。在贫血相关因素的多元线性回归分析中,包括年龄,肾功能(eGFR),营养状况,炎症,和铁动力学(血清铁水平,总铁结合能力,铁蛋白水平),血清磷酸盐水平与Hb水平显着相关(系数[95%置信区间],-0.73[-1.1,-0.35];P<0.001)。亚组分析显示血清磷酸盐水平和低铁蛋白中的Hb水平之间存在密切关联(系数[95%置信区间],-0.94[-1.53,-0.35];P=0.002)和晚期CKD组(系数[95%置信区间],-0.89[-1.37,-0.41];P<0.001)。
结论:我们发现在未接受贫血治疗的CKD患者中,高血清磷酸盐水平和低Hb水平之间存在关联。这些结果强调了CKD-MBD和贫血之间机制重叠的可能性。
Patients with chronic kidney disease (CKD) present high mortality and morbidity rates despite the availability of various therapies. Although CKD-mineral and bone disorder (MBD) and renal anemia are important factors in patients with CKD, only few studies have analyzed the relationship between them. Therefore, this study aimed to evaluate the relationship between CKD-MBD and anemia in patients with CKD who did not receive erythropoiesis-stimulating agent or iron therapies.
This retrospective cross-sectional study included patients with CKD aged ≥ 20 years with estimated glomerular filtration rate (eGFR) categories G2a to G5 who were referred to the Fuji City General Hospital between April 2018 and July 2019. The exclusion criterion was ongoing treatment for CKD-MBD and/or anemia.
The data of 300 patients with CKD were analyzed in this study. The median age of patients was 71 (range, 56.5-79) years. The median eGFR was 34 (range, 20-48) mL/min/1.73 m2, and the mean hemoglobin (Hb) level was 12.7 g/dL (standard deviation, 2.3), which decreased as the CKD stage increased. In a multivariate linear regression analysis of anemia-related factors, including age, renal function (eGFR), nutritional status, inflammation, and iron dynamics (serum iron level, total iron-binding capacity, ferritin levels), the serum phosphate levels were significantly associated with the Hb levels (coefficient [95% confidence interval], -0.73 [-1.1, -0.35]; P < 0.001). Subgroup analysis revealed a robust association between serum phosphate levels and Hb levels in the low-ferritin (coefficient [95% confidence interval], -0.94 [-1.53, -0.35]; P = 0.002) and advanced CKD groups (coefficient [95% confidence interval], -0.89 [-1.37, -0.41]; P < 0.001).
We found an association between high serum phosphate levels and low Hb levels in patients with CKD not receiving treatment for anemia. These results underscore the possibility of a mechanistic overlap between CKD-MBD and anemia.