无贫血的慢性肾病患者缺铁与肾脏预后和全因死亡率的关系。

IF 4.4 2区医学 Q1 NUTRITION & DIETETICS

Nutrition Journal Pub Date : 2025-01-15 DOI:10.1186/s12937-025-01072-1

Hongxue Yu, Xian Shao, Zhixin Guo, Mingzhen Pang, Shan Chen, Caoxiang She, Lisha Cao, Fan Luo, Ruixuan Chen, Shiyu Zhou, Xin Xu, Sheng Nie

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引用次数: 0

摘要

背景：缺铁在慢性肾脏疾病（CKD）患者中很普遍，即使在没有贫血的患者中也是如此。然而，在无贫血的非透析依赖性CKD （NDD-CKD）患者中，缺铁对CKD进展和全因死亡率的影响仍不完全清楚。方法：这项多中心回顾性全国队列研究纳入了来自中国24家医院的非贫血性NDD-CKD成年患者。该研究调查了血清铁蛋白或转铁蛋白饱和度（TSAT）水平与CKD进展风险和全因死亡率之间的关系。结果：在18878例NDD-CKD患者中，9989例患者被纳入肾脏结局分析，18481例患者被纳入全因死亡率分析。在接受检测的患者中，2450例（27.2%）患者的铁蛋白水平≤100ng/mL， 2440例（13.1%）患者的TSAT水平≤20%。与TSAT≤20%的患者相比，TSAT≤20%的患者CKD进展的风险显著增加(校正风险比[aHR]: 1.66, 95%可信区间[CI]: 1.16-2.37；P = 0.005)和全因死亡率(aHR: 2.21, 95% CI: 1.36-3.57；p = 0.001)。亚组分析支持结果的稳健性。然而，铁蛋白水平与CKD进展风险或全因死亡率之间没有显著关联（P < 0.05）。结论：铁缺乏在无贫血的NDD-CKD患者中普遍存在，TSAT可能是CKD进展和全因死亡率的可改变危险因素。在NDD-CKD早期筛选铁生物标志物，特别是TSAT，对评估和改善预后具有重要意义。

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Association of iron deficiency with kidney outcome and all-cause mortality in chronic kidney disease patients without anemia.

Background: Iron deficiency is prevalent in patients with chronic kidney disease (CKD), even in those without anemia. However, the effects of iron deficiency on CKD progression and all-cause mortality in non-dialysis-dependent CKD (NDD-CKD) patients without anemia remain incompletely understood.

Methods: This multicenter retrospective nationwide cohort study included adult patients with non-anemia NDD-CKD from 24 hospitals across China. The study investigated the associations between serum ferritin or transferrin saturation (TSAT) levels and the risks of CKD progression and all-cause mortality.

Results: Among 18,878 patients with NDD-CKD, 9,989 patients were included in the kidney outcome analysis, and 18,481 patients in the all-cause mortality analysis. Of the patients with the measurement, 2,450 (27.2%) had ferritin levels ≤ 100ng/mL and 2,440 (13.1%) had a TSAT level ≤ 20%. Compared with patients with TSAT level of > 20%, those with TSAT level of ≤ 20% had significantly higher risks of CKD progression (adjusted hazard ratio [aHR]: 1.66, 95% confidence intervals [CI]: 1.16-2.37; P = 0.005) and all-cause mortality (aHR: 2.21, 95% CI: 1.36-3.57; P = 0.001). The robustness of results was supported by subgroup analyses. However, there was no significant association found between ferritin levels and the risk of CKD progression or all-cause mortality (P > 0.05).

Conclusion: Iron deficiency was prevalent in NDD-CKD patients without anemia, and TSAT could be a modifiable risk factor of CKD progression and all-cause mortality. The screening of iron biomarkers, especially TSAT, in the early stage of NDD-CKD is important to assess and improve prognosis.

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来源期刊

Nutrition Journal NUTRITION & DIETETICS-

CiteScore

9.80

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： Nutrition Journal publishes surveillance, epidemiologic, and intervention research that sheds light on i) influences (e.g., familial, environmental) on eating patterns; ii) associations between eating patterns and health, and iii) strategies to improve eating patterns among populations. The journal also welcomes manuscripts reporting on the psychometric properties (e.g., validity, reliability) and feasibility of methods (e.g., for assessing dietary intake) for human nutrition research. In addition, study protocols for controlled trials and cohort studies, with an emphasis on methods for assessing dietary exposures and outcomes as well as intervention components, will be considered. Manuscripts that consider eating patterns holistically, as opposed to solely reductionist approaches that focus on specific dietary components in isolation, are encouraged. Also encouraged are papers that take a holistic or systems perspective in attempting to understand possible compensatory and differential effects of nutrition interventions. The journal does not consider animal studies. In addition to the influence of eating patterns for human health, we also invite research providing insights into the environmental sustainability of dietary practices. Again, a holistic perspective is encouraged, for example, through the consideration of how eating patterns might maximize both human and planetary health.