背景:尽管长效红细胞生成刺激剂(ESA)的广泛使用促进了慢性肾脏病(CKD)患者贫血的改善,预后改善尚未得到充分证实.缺铁与心血管疾病(CVD)的发展有关,红细胞生成刺激剂引起的相对铁缺乏可能阻止预后的改善。因此,我们研究了在使用转铁蛋白饱和度(TSAT)的长效红细胞生成刺激剂治疗期间铁缺乏与心血管事件之间的关系,比铁蛋白更不容易发炎。
方法:本研究包括1040例非透析依赖性CKD患者,年龄≥20岁,肾小球滤过率<60mL/min/1.73m2,血红蛋白<11g/dL,接受达贝泊汀阿尔法治疗96周。这些患者是在BRIGHTEN试验中招募的,一个多中心,prospective,进行的观察性研究旨在评估临床上治疗非透析依赖性CKD贫血时对darbepoetinalfa的红细胞生成刺激剂耐药性。使用Kaplan-Meier方法评估转铁蛋白饱和度与心血管事件累积发生率之间的关联。要计算危险比(HR),使用95%置信区间(CI)和Cox比例风险模型。
结果:心血管事件的生存曲线分析表明转铁蛋白饱和度≥30%的患者预后明显更好,调整后的风险比为0.34(95%置信区间0.22-0.52)。分层分析显示,转铁蛋白饱和度为30-40%的患者发生心血管事件的风险明显低于转铁蛋白饱和度为20-30%的患者。即使多变量校正后的风险比为0.33(95%置信区间0.21-0.54).
结论:在使用长效红细胞生成刺激剂治疗的患者中,CKD和转铁蛋白饱和度为30-40%的患者的心血管事件明显少于转铁蛋白饱和度为20-30%的患者。因此,从红细胞生成刺激剂反应性和减少心血管事件的角度来看,维持较高的转铁蛋白饱和度可能是有用的.
BACKGROUND: Although the widespread use of long-acting erythropoiesis-stimulating agents (ESAs) has facilitated the improvement of
anemia in patients with chronic kidney disease (CKD), the improvement in prognosis has not been fully demonstrated. Iron deficiency is associated with the development of cardiovascular diseases (CVDs), and the relative iron deficiency induced by erythropoiesis-stimulating agents may prevent the improvement of prognosis. Therefore, we investigated the association between iron deficiency and cardiovascular events during long-acting erythropoiesis-stimulating agent therapy using transferrin saturation (TSAT), which is less susceptible to inflammation than ferritin.
METHODS: This study included 1040 patients with non-dialysis-dependent CKD, aged ≥ 20 years, with a glomerular filtration rate < 60 mL/min/1.73 m2 and hemoglobin < 11 g/dL, who were treated with darbepoetin alfa for 96 weeks. The patients were recruited in the BRIGHTEN Trial, a multicenter, prospective, observational study conducted to evaluate erythropoiesis-stimulating agent resistance to darbepoetin alfa in treating
anemia in non-dialysis-dependent CKD in a clinical setting. The association between transferrin saturation and the cumulative incidence of cardiovascular events was evaluated using the Kaplan-Meier method. To calculate the hazard ratio (HR), 95% confidence intervals (CI) and the Cox proportional hazards model were used.
RESULTS: Survival curve analysis for cardiovascular events indicated that patients with transferrin saturation ≥ 30% had a significantly better prognosis, with an adjusted hazard ratio of 0.34 (95% confidence interval 0.22-0.52). Stratified analysis revealed that patients with transferrin saturation of 30-40% had a significantly lower risk of cardiovascular events than those with transferrin saturation of 20-30%, even after a multivariate-adjusted hazard ratio of 0.33 (95% confidence interval 0.21-0.54).
CONCLUSIONS: Patients with CKD and transferrin saturation of 30-40% had significantly fewer cardiovascular events than those with transferrin saturation of 20-30% among patients treated with long-acting erythropoiesis-stimulating agents. Therefore, it may be useful to maintain higher transferrin saturation from the viewpoint of erythropoiesis-stimulating agent responsiveness and the reduction of cardiovascular events.