慢性肾脏病3～5D期贫血状况的单中心横断面调查

Epidemiology of anemia in patients with stages 3-5D chronic kidney disease: a cross-sectional study in Harbin,Northeast China

目的调查分析慢性肾脏病(chronic kidney disease,CKD)3~5D期患者的贫血状况,分析CKD患者贫血发病规律,为肾性贫血的改善提供参考数据。方法采用单中心横断面回顾性研究设计,选择2011年10月至2015年8月在哈尔滨医科大学附属第一医院门诊规律行血液透析及住院治疗的859例CKD 3~5D期患者做为研究对象。将入选患者依据估算肾小球滤过率(estimated glomerular filtration rate,eGFR)和是否接受透析治疗分成4组,即CKD 3期组(241例)、CKD 4期组(195例)、CKD 5期组(243例)和CKD 5D期组(180例),收集入选患者的血常规及生化等指标,对贫血相关指标及贫血状况进行统计分析。结果随着CKD病情进展,从CKD 3期至CKD 5D期4组患者的血红蛋白(hemoglobin,Hb)水平依次为(119.0±23.2)g/L、(102.3±20.4)g/L、(86.1±19.3)g/L、(101.6±18.2)g/L,组间比较有统计学差异(F=103.48,P<0.01);4组患者贫血患病率依次为43.2%、71.3%、95.9%、78.9%,其中轻度贫血所占各期贫血人数的百分比分别为83.7%、61.9%、51.1%、71.1%。CKD 3~5D期贫血患者的红细胞形态学分类结果显示:正细胞正色素性贫血所占总贫血比例为66.7%。直线回归分析得出Hb与eGFR双变量之间的关系式为:Hb=79.80+0.91×eGFR(R=0.59,F=57.73,P<0.01)。结论随着肾病的进展,CKD患者的贫血患病率逐渐升高,贫血的严重程度也在逐期加重;CKD患者贫血以正细胞正色素性贫血为主,提示CKD患者的贫血在发病机制具上有一致性;CKD 3期至CKD 5期,Hb平均水平随eGFR下降呈线性趋势递减。

Objective To determine the prevalence of anemia in subjects with chronic kidney disease （CKD）3-5, reveal the characteristics of anemia in those patients, and provide data for promo- ting this situation. Methods This was an epidemiological, cross-sectional, single-center study under routine clinical practice conditions. Data of 859 CKD 3-5 patients admitted to the First Affiliated Hos- pital of Harbin Medical University or in its hemodialysis center from October 2011 to August 2015 were used to understand the prevalence of anemia in those patients （stage 3.. n = 241; stage 4： n = 195; stage 5： n = 243; stage 5D： n = 180）. Results The mean hemoglobin （Hb） value for patients with CKD 3 was 119. 0 ± 23. 2 g/L, compared to 102. 3 ± 20. 4 g/L in patients with CKD 4, to 86. 1 ± 19. 3 g/L with CKD 5ND （CKD 5 not on dialysis）, and to 101.6 ± 18. 2 g/L with CKD 5D （CKD 5 on dialysis）. There was statistically significant difference among the groups （F = 103. 48, P〈0. 01）. The overall prevalence of anemia was 43. 2%, 71.3%, 95. 9%, and 78. 9% in patients with CKD 3,CKD 4, CKD 5ND and CKD 5HD, respectively. The prevalence of moderate anemia [-90 g/L≤Hb（ 120 g/L （male）/ll0 g/L （female）] was 83.7% （CKD 3）, 61.9% （CKD 4）, 51.1% （CKD 5）, and 71.1% （CKD 5D） respectively. According to the standard of anemia in China, the patients with nor- mocytic anemia accounted for 66. 7%. The linear regression showed that Hb （g/L） = 79. 80 ± 0. 91×eGFR[-mL.min-l.（l.73 m2）-1] （R=0.59, F=57.73, P（0. 01）. Conclusions We found that the prevalence of anemia was increased with the raised prevalence of CKD 3-5. Normocytic and normo- chromic anemia is the most common form in patients with CKD 3-5D, in accordance with its pathogen- eses. In patients with CKD 3-5, mean Hb level was decreased as eGFR was linearly decreased.