Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts.
Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts.
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DOI：
10.1016/j.ekir.2023.07.032
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发表时间：
2023-10
影响因子：
6
通讯作者：
Levin, Adeera
中科院分区：
文献类型：
--
作者：
Canney, Mark;Induruwage, Dilshani;Tang, Mila;de Pinho, Natalia Alencar;Er, Lee;Zhao, Yinshan;Djurdjev, Ognjenka;Ahn, Yo Han;Behnisch, Rouven;Calice-Silva, Viviane;Chesnaye, Nicholas C.;de Borst, Martin H.;Dember, Laura M.;Dionne, Janis;Ebert, Natalie;Eder, Susanne;Fenton, Anthony;Fukagawa, Masafumi;Furth, Susan L.;Hoy, Wendy E.;Imaizumi, Takahiro;Jager, Kitty J.;Jha, Vivekanand;Kang, Hee Gyung;Kitiyakara, Chagriya;Mayer, Gert;Oh, Kook-Hwan;Onu, Ugochi;Pecoits-Filho, Roberto;Reichel, Helmut;Richards, Anna;Schaefer, Franz;Schaeffner, Elke;Scheppach, Johannes B.;Sola, Laura;Ulasi, Ifeoma;Wang, Jinwei;Yadav, Ashok K.;Zhang, Jianzhen;Feldman, Harold, I;Taal, Maarten W.;Stengel, Benedicte;Levin, Adeera
尽管公认的地理和性别差异的血红蛋白在一般人群中，这些因素通常被忽视的慢性肾脏疾病（CKD）患者的血红蛋白的单一治疗范围的建议。我们试图比较国际非透析CKD人群中血红蛋白的分布，并评估血红蛋白的预测因子。在这项横断面研究中，评价了每个队列的血红蛋白分布，并按性别和估计的肾小球滤过率（eGFR）分层。在每个队列中，通过线性回归模型评估候选预测因子与血红蛋白之间的关系。随后在随机效应模型中合并估计值。来自21个成人队列（中位eGFR范围为17-49 ml/min）和3个儿科队列（中位eGFR范围为26-45 ml/min）的共58，613名参与者被纳入，具有广泛的地理代表性。队列之间、总体和eGFR类别内的血红蛋白值差异很大，在亚洲和非洲队列的女性中观察到的平均血红蛋白值特别低。在eGFR范围内，女性的血红蛋白低于男性，即使eGFR为15 ml/min（平均差异为5.3 g/l，95%置信区间[CI]为3.7-6.9）。较低的eGFR、女性、年龄较大、较低的体重指数和糖尿病肾病都是较低血红蛋白值的独立预测因素;然而，这仅解释了少数方差（各队列的R2 7%-44%）。CKD患者的血红蛋白分布存在显著的地区差异，大部分差异无法通过人口统计学、eGFR或合并症来解释。这些发现呼吁人们重新关注提高我们对特定慢性肾病人群中血红蛋白决定因素的了解。
Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17–49 ml/min) and 3 pediatric cohorts (median eGFR range of 26–45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7–6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%–44% across cohorts). There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.
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影响因子：
11.5
作者：
De Nicola, Luca;Locatelli, Francesco;Minutolo, Roberto
通讯作者：
Minutolo, Roberto
影响因子：
2.3
作者：
Kang HG;Choi HJ;Han KH;Kim SH;Cho HY;Cho MH;Shin JI;Lee JH;Lee J;Oh KH;Park YS;Cheong HI;Ahn C;Ha IS
通讯作者：
Ha IS
影响因子：
3.7
作者：
Mercadal, Lucile;Metzger, Marie;Stengel, Benedicte
通讯作者：
Stengel, Benedicte
影响因子：
6.1
作者：
Eckardt, Kai-Uwe;Baerthlein, Barbara;Titze, Stephanie
通讯作者：
Titze, Stephanie
影响因子：
158.5
作者：
Pfeffer, Marc A.;Burdmann, Emmanuel A.;Toto, Robert
通讯作者：
Toto, Robert