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口服铁替代疗法与慢性病患者的功能衰竭和死亡率的相关性
Shejuti Paul1, Prabin Shrestha2, Keiichi Sumida2
1Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Clinical kidney journal
|November 2, 2023
概括
慢性病患者的口服铁替代疗法 (IRT) 与末期病 (ESKD) 无关,但增加了死亡风险,除了贫血患者. 对非贫血个体需要进一步研究.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
- 内部医学 内部医学
背景情况:
- 口服铁替代疗法 (IRT) 常用于铁缺乏症,但其在慢性病 (CKD) 中的疗效和安全性尚未得到充分证实.
- 慢性病患者通常需要补充铁,但最佳途径及其对主要不良结果的影响尚不清楚.
研究的目的:
- 调查口服IRT与终末期病 (ESKD) 风险和美国老兵患有慢性病的人群的全因死亡率之间的关联.
- 评估口服IRT在CKD患者的安全性和益处,考虑不同的临床子组.
主要方法:
- 在2004年至2018年期间,对美国退伍军人进行了一项全国性队列研究,估计球膜过率<60毫升/分钟/1.73平方米.
- 17,413名口服IRT的新使用者与32,530名没有接受任何IRT的对照者进行了比较,使用倾向得分重叠权重和竞争风险回归模型.
主要成果:
- 口服IRT与ESKD风险增加没有关联 (HR 1.00;P=0.9).
- 口服IRT与所有原因死亡风险显著增加有关 (HR1.06;P=0.01).
- 只有在患有贫血 (血红蛋白<10 g/dL) 的患者中观察到口服IRT较低的死亡风险;在没有贫血,缺铁或充血性心力衰竭的患者中观察到较高的死亡风险.
结论:
- 在CKD患者中,口服IRT与ESKD无关,但与所有原因的死亡率增加有关,特别是在没有贫血,缺铁或心血管疾病的人群中.
- 口服IRT的风险益处概况需要在CKD患者中进行进一步的检查,特别是在没有贫血或缺铁的子组中.
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