Iron status, fibroblast growth factor 23 and cardiovascular and kidney outcomes in chronic kidney disease.
Iron status, fibroblast growth factor 23 and cardiovascular and kidney outcomes in chronic kidney disease.
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DOI：
10.1016/j.kint.2021.07.013
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发表时间：
2021-12
影响因子：
19.6
通讯作者：
CRIC Study Investigators
中科院分区：
文献类型：
--
作者：
Mehta RC;Cho ME;Cai X;Lee J;Chen J;He J;Flack J;Shafi T;Saraf SL;David V;Feldman HI;Isakova T;Wolf M;CRIC Study Investigators
铁和矿物质稳态紊乱是慢性肾脏疾病的相关并发症，可能影响心血管和肾脏结局。在对慢性肾功能不全队列研究的3747名参与者进行的前瞻性分析中，我们根据铁状态调查了死亡率，心力衰竭，终末期肾病（ESKD）和动脉粥样硬化性心血管疾病的风险，并测试了C-末端成纤维细胞生长因子23（FGF 23），血红蛋白和甲状旁腺激素的介导作用。根据转铁蛋白饱和度和铁蛋白的四分位数，研究参与者被不可知地分类为：（27.1%的参与者;所有结果分析的参照组），“缺铁”（11.1%），“功能性缺铁”（7.6%），“混合性缺铁症”（铁指数在缺铁和功能性缺铁组之间; 6.3%），“高铁”（9.2%）或“未分类”（其余38.8%的参与者）。在多变量校正的考克斯模型中，铁缺乏与死亡率（风险比1.28，95%置信区间1.04-1.58）和心力衰竭（1.34，1.05-1.72）独立相关。混合性铁缺乏与死亡率（1.61，1.27-2.04）和ESKD（1.33，1.02-1.73）相关。高铁与死亡率（1.54，1.24-1.91）、心力衰竭（1.58，1.21-2.05）和ESKD（1.41，1.13-1.77）相关。功能性缺铁与任何结果均无显著相关性，且无铁组与动脉粥样硬化性心血管疾病显著相关。在候选促进者中，FGF 23最显著地介导了由缺铁引起的死亡率和心力衰竭的风险。因此，铁稳态的改变与慢性肾脏疾病患者的心血管和肾脏不良结局相关。
Disordered iron and mineral homeostasis are interrelated complications of chronic kidney disease that may influence cardiovascular and kidney outcomes. In a prospective analysis of 3747 participants in the Chronic Renal Insufficiency Cohort Study, we investigated risks of mortality, heart failure, end-stage kidney disease (ESKD), and atherosclerotic cardiovascular disease according to iron status, and tested for mediation by C-terminal fibroblast growth factor 23 (FGF23), hemoglobin and parathyroid hormone. Study participants were agnostically categorized based on quartiles of transferrin saturation and ferritin as: “Iron Replete” (27.1% of participants; referent group for all outcomes analyses), “Iron Deficiency” (11.1%), “Functional Iron Deficiency” (7.6%), “Mixed Iron Deficiency” (iron indices between the Iron Deficiency and Functional Iron Deficiency groups; 6.3%), “High Iron” (9.2%), or “Non-Classified” (the remaining 38.8% of participants). In multivariable-adjusted Cox models, Iron Deficiency independently associated with mortality (hazard ratio 1.28, 95% confidence interval 1.04–1.58) and heart failure (1.34, 1.05–1.72). Mixed Iron Deficiency associated with mortality (1.61, 1.27–2.04) and ESKD (1.33, 1.02–1.73). High Iron associated with mortality (1.54, 1.24–1.91), heart failure (1.58, 1.21–2.05), and ESKD (1.41, 1.13–1.77). Functional Iron Deficiency did not significantly associate with any outcome, and no iron group significantly associated with atherosclerotic cardiovascular disease. Among the candidate facilitators, FGF23 most significantly mediated the risks of mortality and heart failure conferred by Iron Deficiency. Thus, alterations in iron homeostasis associated with adverse cardiovascular and kidney outcomes in patients with chronic kidney disease.
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DOI：
10.1053/j.ajkd.2009.12.030
发表时间：
2010-04
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Babitt JL;Lin HY
通讯作者：
Lin HY
DOI：
10.1056/nejmoa0706130
发表时间：
2008-08-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Gutiérrez OM;Mannstadt M;Isakova T;Rauh-Hain JA;Tamez H;Shah A;Smith K;Lee H;Thadhani R;Jüppner H;Wolf M
通讯作者：
Wolf M
影响因子：
20.1
作者：
Chang HC;Shapiro JS;Ardehali H
通讯作者：
Ardehali H
影响因子：
13.6
作者：
Eisenga, Michele F.;van Londen, Marco;Gaillard, Carlo A. J. M.
通讯作者：
Gaillard, Carlo A. J. M.
影响因子：
7
作者：
Imai, Kosuke;Keele, Luke;Tingley, Dustin
通讯作者：
Tingley, Dustin