血液透析患者的感染风险和血红蛋白水平的变异性,Kidney International Reports

在慢性肾病贫血的治疗中，血红蛋白水平通常低于或超过目标范围。过去对使用传统红细胞生成刺激剂（ESA）进行血液透析的患者进行的回顾性队列研究发现，血红蛋白水平波动可预测死亡率和心血管不良事件；此后，长效药物被广泛使用。需要通过前瞻性队列研究进行更新验证。

使用 Cox 回归模型，我们评估了来自日本透析结果和实践模式研究 (J-DOPPS) 的 3063 名血液透析患者数据中血红蛋白变异性与全因死亡、住院治疗以及心血管、血栓或感染不良事件结果之间的关联。 2012年至2018年。

在中位随访时间 2.5 年期间，全因死亡率在第一个四分位数中最低，并且在血红蛋白变异性较大的组中往往较高（风险比 [HR]：绝对死亡率第四个四分位数的 95% 置信区间）血红蛋白变异性值：1.44 [0.99–2.08]，趋势P = 0.056）。这些患者的感染事件发生率在第一个四分位数中也低于其他四分位数（趋势P < 0.01）。这种关联在血清铁蛋白水平较低或补充铁剂的患者中更为明显。心血管和血栓事件的发生率与血红蛋白变异性无关。

接受 ESA 治疗的维持性血液透析患者的血红蛋白变异性较高，其全因死亡率尤其是感染事件的风险较高。

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Introduction

In the management of anemia in chronic kidney disease, hemoglobin levels often fall below or exceed target ranges. Past retrospective cohort studies of patients undergoing hemodialysis with conventional erythropoiesis stimulating agents (ESAs) found that hemoglobin level fluctuations predicted mortality and cardiovascular adverse events; long-acting agents were thereafter widely available. An updated validation by a prospective cohort study was needed.

Using Cox regression models, we evaluated associations between hemoglobin variability and all-cause death, hospitalization, and cardiovascular, thrombotic, or infectious adverse event outcomes in 3063 hemodialysis patients’ data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) from 2012 to 2018.

During a median follow-up time of 2.5 years, all-cause mortality was lowest in the first quartile and tended to be higher in groups with greater hemoglobin variability (hazard ratio [HR]: 95% confidence interval for the fourth quartile of an absolute value of hemoglobin variability: 1.44 [0.99–2.08], P for trend = 0.056). Infectious event incidence in these patients was also lower in the first quartile than for the other quartiles (P for trend < 0.01). The association was more pronounced in patients with lower serum ferritin levels or iron supplementation. Cardiovascular and thrombotic event incidence was not associated with hemoglobin variability.

Maintenance hemodialysis patients on ESA treatment with higher hemoglobin variability are at higher risk for all-cause mortality and particularly infectious events.