Thresholds of iron markers for iron deficiency erythropoiesis-finding of the Japanese nationwide dialysis registry
Thresholds of iron markers for iron deficiency erythropoiesis-finding of the Japanese nationwide dialysis registry
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DOI：
10.1038/kisup.2015.6
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发表时间：
2015-06-01
影响因子：
5.5
通讯作者：
Tsubakihara, Yoshiharu
中科院分区：
文献类型：
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作者：
Hamano, Takayuki;Fujii, Naohiko;Tsubakihara, Yoshiharu
据报道，日本血液透析 (HD) 患者的血清铁蛋白水平比西方患者低得多。因此，铁蛋白和转铁蛋白饱和度 (TSAT) 缺铁的临界值可能与其他国家不同。我们利用日本全国登记数据进行了一项横断面观察研究。我们招募了 142,339 名维持性 HD 患者，并利用限制三次样条分析评估了这些标记物、血红蛋白 (Hb) 和促红细胞生成剂 (ESA) 抵抗指数 (ERI) 之间的关联。中位铁蛋白和 TSAT 水平分别为 73 (IQR: 31-158) ng/ml 和 23.7 (16.8-32.0)%。这些较低的铁蛋白范围可能源于日本患者较低的炎症状态，如中位 CRP 为 1.0 mg/l 所示。 Hb 和 TSAT 之间调整后的非线性关联表明，无论血清铁蛋白水平如何，Hb 水平都会随着 TSAT 降低至 20% 以下而下降，这表明 TSAT 的绝对缺铁临界点为 20%。在 TSAT >20% 的患者中，Hb 和铁蛋白水平之间的相关性几乎持平，而在 TSAT 的患者中
Reportedly, serum ferritin levels are much lower in Japanese hemodialysis (HD) patients than their Western counterparts. Therefore, the cutoff values of ferritin and transferrin saturation (TSAT) for iron deficiency might differ from other countries. We conducted a cross-sectional observational study using the Japanese nationwide registry data. We enrolled 142,339 maintenance HD patients and assessed the association between these markers, hemoglobin (Hb), and erythropoiesis-stimulating agent (ESA) resistance index (ERI) utilizing restricted cubic spline analyses. Median ferritin and TSAT levels were 73 (IQR: 31-158) ng/ml and 23.7 (16.8-32.0)%, respectively. These lower ferritin ranges may possibly stem from a lower inflammatory state in Japanese patients, as shown in median CRP of 1.0 mg/l. An adjusted nonlinear association between Hb and TSAT showed that Hb levels drop with the decrease in TSAT below 20%, regardless of serum ferritin levels, suggesting the absolute iron deficiency cutoff as 20% for TSAT. In patients with TSAT >20%, the association between Hb and ferritin levels is nearly flat, whereas in patients with TSAT