Low Levels of Serum Ferritin Lead to Adequate Hemoglobin Levels and Good Survival in Hemodialysis Patients
Low Levels of Serum Ferritin Lead to Adequate Hemoglobin Levels and Good Survival in Hemodialysis Patients
复制标题
DOI：
10.1159/000370317
复制
发表时间：
2015-01
影响因子：
4.2
通讯作者：
Chie Ogawa;K. Tsuchiya;F. Kanda;T. Maeda
中科院分区：
文献类型：
--
作者：
Chie Ogawa;K. Tsuchiya;F. Kanda;T. Maeda
背景：血液透析（HD）患者控制贫血和提高生存率的最佳血清铁蛋白（s-ft）水平尚不清楚。一项为期10年的调查旨在明确s-ft的适当量，并研究HD患者s-ft、转铁蛋白饱和度（TSAT）和死亡率之间的关系。方法：采用促红细胞生成素（ESA）治疗的HD门诊患者125例，随访10年。根据日本指南，调整ESA和低剂量铁补充剂剂量以维持血红蛋白（Hb）在10-11 g/dl。采用Kaplan-Meier法、log-rank检验和Cox比例风险模型进行统计分析。使用多元线性回归模型分析Hb、s-ft和TSAT之间的相互作用。TSAT≥20%的患者按s-ft临界值分类：1组（s-ft 80 ng/ml）；TSAT <20%是预后不良的预测因子。结果：2组患者生存率显著高于其他组（p = 0.013）， Cox比例风险模型分析显示低s-ft水平对患者生存率有较好的影响。多元线性回归模型显示s-ft对Hb有很强的影响（log [s-ft]， β-系数- 0.45:95%置信区间- 0.65 ~ - 0.26,p < 0.001）。结论：本研究表明，低水平的s-ft对接受ESA治疗的HD患者的预后有有益的影响。因此，最佳s-ft水平可能低于先前为这些患者建立的水平。
Background: The optimal level of serum ferritin (s-ft) for anemia control and good survival in hemodialysis (HD) patients remains unclear. A 10-year survey was performed to clarify the appropriate quantities of s-ft and investigate the relationships among s-ft, transferrin saturation (TSAT), and mortality in HD patients. Methods: HD outpatients (n = 125) treated with erythropoiesis-stimulating agents (ESA) were followed for 10 years. The ESA and low-dose iron supplement dosages were adjusted to maintain the hemoglobin (Hb) at 10-11 g/dl, according to Japanese guidelines. The Kaplan-Meier method, log-rank tests, and the Cox proportional hazards model were used for performing the statistical analyses. The interactions among the Hb, s-ft, and TSAT were analyzed using a multiple linear regression model. Patients with TSAT ≥20% were classified according to the s-ft cutoff values: group 1 (s-ft 80 ng/ml); TSAT <20% was a predictor of poor outcome. Results: The survival rate in group 2 was significantly higher than that in other groups (p = 0.013), and the Cox proportional hazards model analysis showed a good effect of low levels of s-ft on patients' survival. The multiple linear regression model showed a strong effect of s-ft on the Hb (log [s-ft], β-coefficient −0.45: 95% confidence interval −0.65 to −0.26, p < 0.001). Conclusion: This study revealed that low levels of s-ft have a beneficial effect on the outcome of HD patients receiving ESA. Thus, the optimal s-ft level might be lower than that established previously for these patients.