在接受血液透析的患者中,感染风险和血红蛋白水平的变化
Hiroshi Nishi1, Jui Wang2,3, Yoshihiro Onishi3
1Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Kidney international reports
|September 14, 2023
概括
在接受红色素形成刺激剂 (ESA) 的血液透析患者中,血球蛋白的变异性与死亡率和感染事件的增加有关,特别是在铁含量低的患者中.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血液学 血液学 血液学
- 临床流行病学临床流行病学
背景情况:
- 慢性病 (CKD) 中的贫血管理经常涉及血红蛋白水平的波动.
- 之前的研究表明,血红蛋白变异性预测了常规红色素形成刺激剂 (ESA) 的血液透析患者的死亡率和心血管事件.
- 需要更新的前性验证来确认这些关联.
研究的目的:
- 评估血红蛋白变异性与血液透析患者不良结果之间的关联.
- 评估与血红蛋白水平波动相关的全因死亡,住院和心血管,血栓或传染病事件的风险.
主要方法:
- 在2012年至2018年的日本透析结果和实践模式研究 (J-DOPPS) 中,利用了来自3063名透析患者的数据的考克斯回归模型.
- 评估了血红蛋白变异性和死亡率,住院和特定不良事件之间的关联.
- 基于血清费里水平和补充铁的分析子组效应.
主要成果:
- 较高的血红蛋白变异性与全因死亡率的增加有关 (第四季度的HR:1.44 [0.99-2.08],P趋势=0.056).
- 在血红蛋白变化的最低四分位数中,感染事件发生率明显较低 (P趋势<0.01).
- 血红蛋白变异性与死亡率/传染性事件之间的关联在血清费里含量较低或补充铁的患者中更为明显;对于心血管或血栓性事件没有发现关联.
结论:
- 用ESA治疗的维持血液透析患者表现出更高的血红蛋白变异性,面临更高的风险.
- 这些风险对于全因死亡率和传染病事件特别重要.
- 铁状况似乎改变了血红蛋白变异性对不良结果的影响.
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