2020年山西省腹膜透析患者贫血的流行病学调查及相关因素分析

doi:10.3877/cma.j.issn.2095-3216.2023.03.001

目的

对山西省腹膜透析(PD)患者的贫血进行流行病学调查并分析相关因素。

方法

筛选2020年全国血液净化病例登记系统的山西省PD患者病例，收集基本资料、透析状况、药物使用及实验室指标。血红蛋白(Hb)≥110 g/L视为治疗达标。

结果

2020年山西省PD患者血红蛋白(Hb)水平为(104.9±18.3)g/L，Hb总体达标率为40.2%。红细胞生成刺激剂使用率为97.1%，口服铁剂使用率为98.3%，静脉铁剂使用率为1.7%。男性Hb达标率高于女性；随年龄增长，Hb达标率呈增高趋势。与Hb达标患者相比，Hb未达标组患者的女性比例、透析龄、每周红细胞生成刺激剂剂量，持续不卧床PD患者每日透析液剂量、血肌酐及血磷较高，而平均年龄、职业稳定程度、血钙及血白蛋白较低(均P<0.05)。多因素Logistic回归分析显示，年龄<45岁、甲状旁腺激素>500 ng/L和血白蛋白<35 g/L为Hb未达标的风险因素。

结论

2020年山西省PD患者Hb≥110 g/L者占40.2%。年龄<45岁、甲状旁腺激素>500 ng/L、血白蛋白<35 g/L为Hb未达标的风险因素。加强年轻患者的健康宣教和慢病管理，调节好钙磷代谢，控制继发性甲状旁腺功能亢进及增强营养，可能有助于改善山西省PD患者的贫血情况。

关键词: 腹膜透析, 肾性贫血, 血红蛋白, 红细胞生成刺激素, 风险因素

Objective

To perform epidemiological investigation on anemia in peritoneal dialysis (PD) patients in Shanxi Province in 2020 and analyze related factors.

Methods

Data of PD patients in Shanxi Province in 2020, registered in the Chinese National Renal Data System (CNRDS), were collected including basic information, dialysis status, drug use, and laboratory indicators. Hemoglobin (Hb)≥110 g/L was regarded as Hb level success.

Results

In 2020, the average Hb level of PD patients in Shanxi Province was (104.9±8.3) g/L, and the overall rate of Hb level success was 40.2%. The usage rate of erythropoietic stimulating agents (ESAs) was 97.1%. The usage rate of oral iron was 98.3%, while the usage rate of intravenous iron was 1.7%. The Hb level success rate was higher in the male than in the female patients. The Hb level success rate increased with age. Compared with the patients with Hb level success, those patients without Hb level success showed higher levels in the proportion of females, age of dialysis, weekly dose of ESAs, daily dialysate dose of patients with continuous ambulatory PD (CAPD), serum creatinine, and serum phosphorus, but lower levels in the average age, occupational stability, serum calcium, and serum albumin (all P<0.05). Multivariate logistic regression analysis showed that age<45 years old, parathyroid hormone >500 ng/L, and serum albumin <35 g/L were risk factors for the Hb level without success.

Conclusion

In Shanxi Province in 2020, 40.2% PD patients had an Hb level of no less than 110 g/L. The risk factors for the Hb level to be less than 110 g/L included the age <45 years old, parathyroid hormone >500 ng/L, and serum albumin <35 g/L. Strengthening health education and chronic disease management for the young PD patients, well regulating calcium and phosphorus metabolism, controlling secondary hyperparathyroidism, and enhancing nutrition may be helpful to improve the anemia situation in the PD patients in Shanxi Province.

Key words: Peritoneal dialysis, Renal anemia, Hemoglobin, Erythropoietic stimulating agents, Risk factors

表1 患者一般临床资料及治疗情况对比

指标	未达标组	达标组	t/χ²/Z值	P值
性别(男/女)^a	45.7%/54.3%	55.1%/44.9%	4.138	0.042
年龄(岁)^b	49.74±14.75	52.56±15.3	2.036	0.042
教育程度[例(%)]^a			2.160	0.340
大专及以上	23(11.6)	17(12.0)
高中及中专	45(22.6)	23(16.2)
初中及以下	131(65.8)	102(71.8)
职业[例(%)]^a			5.273	0.022
稳定	51(34.2)	51(48.6)
不稳定	98(65.8)	54(51.4)
体质指数(kg/m²)^b	22.71±3.43	23.11±3.19	1.199	0.231
原发病[(例)%]^a			2.049	0.359
原发性肾小球病	189(79.7)	120(74.0)
高血压病	30(12.7)	24(14.8)
糖尿病	18(7.6)	18(11.2)
透析龄(月)^b	31.73±26.27	25.46±21.50	－2.778	0.006
透析前收缩压(mmHg)^b	141.7±22.17	137.8±18.17	－1.928	0.055
透析方式[(例)%]^a			3.085	0.214
CAPD	211(92.5)	143(87.7)
IPD	10(4.4)	14(8.6)
TPD	7(3.1)	6(3.7)
CAPD每日透析液剂量(L)^c	7.54±1.5	6.92±1.52	－3.451	0.01
透析液类型[(例)%]^a			1.498	0.221
国产	90(38.8)	75(44.9)
进口	142(61.2)	92(55.1)
总肌酐清除率[(例)%]^a			0.61	0.805
<50	47(29.6)	42(30.9)
≥50	112(70.4)	94(69.1)
总尿素清除分数[(例)%]^a			0.234	0.628
<1.7	55(34.6)	50(37.3)
≥1.7	104(65.4)	84(62.7)
腹膜平衡实验[(例)%]^a			5.493	0.139
高转运	7(9.6)	5(8.3)
高平均转运	35(47.9)	18(30.0)
低平均转运	29(39.8)	33(55.0)
低转运	2(2.7)	4(6.7)
ESAs使用种类^a			0.858	0.354
国产	186(95.4)	102(91.9)
进口	9(4.6)	9(8.1)
每周ESAs剂量(U)^b	7492.17±2914.09	6454.24±2791.82	－2.287	0.024
口服铁剂[(例)%]^a	77(26.5)	41(20.9)	1.959	0.162
血总钙(mmol/L)^b	2.19±0.21	2.25±0.26	2.447	0.015
血磷(mmol/L)^c	1.63±0.47	1.54±0.42	－2.272	0.023
血甲状旁腺激素(ng/L)^c	395.13±291.14	306.41±291.14	－0.286	0.004
血尿素氮(mmol/L)^c	19.71±6.00	20.10±8.44	－0.393	0.694
血肌酐(μmol/L)^b	848.74±294.98	735.97±244.80	－3.839	0.000
血尿酸(μmol/L)c	388.22±241.34	364.25±82.13	－1.315	0.188
血白蛋白(g/L)^b	33.89±5.31	35.59±4.41	3.716	0.000
血胆固醇(mmol/L)^c	4.54±1.06	5.50±1.13	－0.175	0.861
血甘油三酯(mmol/L)^c	1.82±1.25	1.69±0.76	－0.400	0.689
血碳酸氢根浓度(mmol/L)^b	25.73±3.87	26.06±3.02	0.750	0.454
血C反应蛋白(mg/L)^c	4.60±12.92	0.96±1.25	－0.811	0.481

表1 患者一般临床资料及治疗情况对比

指标	未达标组	达标组	t/χ²/Z值	P值
性别(男/女)^a	45.7%/54.3%	55.1%/44.9%	4.138	0.042
年龄(岁)^b	49.74±14.75	52.56±15.3	2.036	0.042
教育程度[例(%)]^a			2.160	0.340
大专及以上	23(11.6)	17(12.0)
高中及中专	45(22.6)	23(16.2)
初中及以下	131(65.8)	102(71.8)
职业[例(%)]^a			5.273	0.022
稳定	51(34.2)	51(48.6)
不稳定	98(65.8)	54(51.4)
体质指数(kg/m²)^b	22.71±3.43	23.11±3.19	1.199	0.231
原发病[(例)%]^a			2.049	0.359
原发性肾小球病	189(79.7)	120(74.0)
高血压病	30(12.7)	24(14.8)
糖尿病	18(7.6)	18(11.2)
透析龄(月)^b	31.73±26.27	25.46±21.50	－2.778	0.006
透析前收缩压(mmHg)^b	141.7±22.17	137.8±18.17	－1.928	0.055
透析方式[(例)%]^a			3.085	0.214
CAPD	211(92.5)	143(87.7)
IPD	10(4.4)	14(8.6)
TPD	7(3.1)	6(3.7)
CAPD每日透析液剂量(L)^c	7.54±1.5	6.92±1.52	－3.451	0.01
透析液类型[(例)%]^a			1.498	0.221
国产	90(38.8)	75(44.9)
进口	142(61.2)	92(55.1)
总肌酐清除率[(例)%]^a			0.61	0.805
<50	47(29.6)	42(30.9)
≥50	112(70.4)	94(69.1)
总尿素清除分数[(例)%]^a			0.234	0.628
<1.7	55(34.6)	50(37.3)
≥1.7	104(65.4)	84(62.7)
腹膜平衡实验[(例)%]^a			5.493	0.139
高转运	7(9.6)	5(8.3)
高平均转运	35(47.9)	18(30.0)
低平均转运	29(39.8)	33(55.0)
低转运	2(2.7)	4(6.7)
ESAs使用种类^a			0.858	0.354
国产	186(95.4)	102(91.9)
进口	9(4.6)	9(8.1)
每周ESAs剂量(U)^b	7492.17±2914.09	6454.24±2791.82	－2.287	0.024
口服铁剂[(例)%]^a	77(26.5)	41(20.9)	1.959	0.162
血总钙(mmol/L)^b	2.19±0.21	2.25±0.26	2.447	0.015
血磷(mmol/L)^c	1.63±0.47	1.54±0.42	－2.272	0.023
血甲状旁腺激素(ng/L)^c	395.13±291.14	306.41±291.14	－0.286	0.004
血尿素氮(mmol/L)^c	19.71±6.00	20.10±8.44	－0.393	0.694
血肌酐(μmol/L)^b	848.74±294.98	735.97±244.80	－3.839	0.000
血尿酸(μmol/L)c	388.22±241.34	364.25±82.13	－1.315	0.188
血白蛋白(g/L)^b	33.89±5.31	35.59±4.41	3.716	0.000
血胆固醇(mmol/L)^c	4.54±1.06	5.50±1.13	－0.175	0.861
血甘油三酯(mmol/L)^c	1.82±1.25	1.69±0.76	－0.400	0.689
血碳酸氢根浓度(mmol/L)^b	25.73±3.87	26.06±3.02	0.750	0.454
血C反应蛋白(mg/L)^c	4.60±12.92	0.96±1.25	－0.811	0.481

表2 影响Hb未达标的多因素Logistic回归分析

指标	回归系数	Wald卡方	P值	OR值	95%CI
年龄<45岁	0.481	4.632	0.031	1.617	1.044~2.506
甲状旁腺激素>500 ng/L	0.590	5.273	0.022	1.804	1.090~2.986
血白蛋白<35 g/L	0.556	0.202	0.006	1.744	1.173~2.593
常量	－0.058	0.122	0.727	0.943

表2 影响Hb未达标的多因素Logistic回归分析

指标	回归系数	Wald卡方	P值	OR值	95%CI
年龄<45岁	0.481	4.632	0.031	1.617	1.044~2.506
甲状旁腺激素>500 ng/L	0.590	5.273	0.022	1.804	1.090~2.986
血白蛋白<35 g/L	0.556	0.202	0.006	1.744	1.173~2.593
常量	－0.058	0.122	0.727	0.943

[1]	Astor BC, Muntner P, Levin A, et al. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988-1994) [J]. Arch Intern Med, 2002, 162(12): 1401-1408.
[2]	Rauchhaus M, Clark AL, Doehner W, et al. The relationship between cholesterol and survival in patients with chronic heart failure [J]. J Am Coll Cardiol, 2003, 42(11): 1933-1940.
[3]	Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline [J]. Ann Intern Med, 2013, 158(11): 825-830.
[4]	Caldararu CD, Tarta DI, Gliga ML, et al. Comparative analysis of hepcidin-25 and inflammatory markers in patients with chronic kidney disease with and without anemia [J]. Acta Med Marisiensis, 2017, 63(3): 10-14.
[5]	Zadrazil J, Horak P. Pathophysiology of anemia in chronic kidney diseases: a review [J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(2): 197-202.
[6]	Bataille S, Pelletier M, Sallee M, et al. Indole 3-acetic acid, indoxyl sulfate and paracresyl-sulfate do not influence anemia parameters in hemodialysis patients [J]. BMC Nephrol, 2017, 18(1): 251.
[7]	Toft G, Heide-Jorgensen U, van Haalen H, et al. Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study [J]. J Nephrol, 2020, 33(1): 147-156.
[8]	Mukhopadhyay P, Sinha U, Banerjee J, et al. The effects in correction of anaemia in chronic kidney disease with erythropoietin therapy--preference to cardiovascular, neurologic and general well-being of patients from a tertiary care centre [J]. J Indian Med Assoc, 2012, 110(12): 885-888.
[9]	Rao M, Pereira BJ. Optimal anemia management reduces cardiovascular morbidity, mortality, and costs in chronic kidney disease [J]. Kidney Int, 2005, 68(4): 1432-1438.
[10]	中国医师协会肾脏内科医师分会肾性贫血指南工作组. 中国肾性贫血诊治临床实践指南[J]. 中华医学杂志，2021, 101(20): 1463-1502.
[11]	Zhou QG, Jiang JP, Wu SJ, et al. Current pattern of Chinese dialysis units: a cohort study in a representative sample of units [J]. Chin Med J (Engl), 2012, 125(19): 3434-3439.
[12]	Perlman RL, Zhao J, Fuller DS, et al. International anemia prevalence and management in peritoneal dialysis patients [J]. Perit Dial Int, 2019, 39(6): 539-546.
[13]	Auerbach M, Henry D, Derman RJ, et al. A prospective, multi-center, randomized comparison of iron isomaltoside 1000 versus iron sucrose in patients with iron deficiency anemia; the FERWON-IDA trial [J]. Am J Hematol, 2019, 94(9): 1007-1014.
[14]	Locatelli F, Barany P, Covic A, et al. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European renal best practice position statement [J]. Nephrol Dial Transplant, 2013, 28(6): 1346-1359.
[15]	田延红，田娜，张倩，等. 影响腹膜透析患者血红蛋白水平达标的相关因素分析[J]. 中国血液净化，2020, 19(12): 811-815.
[16]	余少斌，周姣姣，付平，等. 持续性非卧床腹膜透析患者血红蛋白水平分析及相关因素探讨[J]. 中国中西医结合肾病杂志，2016, 17(8): 695-697.
[17]	Meytes D, Bogin E, Ma A, et al. Effect of parathyroid hormone on erythropoiesis [J]. J Clin Invest, 1981, 67(5): 1263-1269.
[18]	Tanaka M, Komaba H, Fukagawa M. Emerging association between parathyroid hormone and anemia in hemodialysis patients [J]. Ther Apher Dial, 2018, 22(3): 242-245.
[19]	Brancaccio D, Cozzolino M, Gallieni M. Hyperparathyroidism and anemia in uremic subjects: a combined therapeutic approach [J]. J Am Soc Nephrol, 2004, 15(Suppl 1): S21-S24.
[20]	Mpio I, Boumendjel N, Karaaslan H, et al. Secondary hyperparathyroidism and anemia. Effects of a calcimimetic on the control of anemia in chronic hemodialysed patients. Pilot study [J]. Nephrol Ther, 2011, 7(4): 229-236.
[21]	Sikole A. Pathogenesis of anemia in hyperparathyroidism [J]. Med Hypotheses, 2000, 54(2): 236-238.
[22]	De Keukeleire S, Muylle K, Tsoumalis G, et al. Primary hyperparathyroidism associated to thrombocytopenia: an issue to consider? [J]. Clin Cases Miner Bone Metab, 2017, 14(1): 97-100.
[23]	Boxer M, Ellman L, Geller R, et al. Anemia in primary hyperparathyroidism [J]. Arch Intern Med, 1977, 137(5): 588-593.
[24]	Kalantar ZK, McAllister CJ, Lehn RS, et al. Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients [J]. Am J Kidney Dis, 2003, 42(4): 761-773.
[25]	Bross R, Zitterkoph J, Pithia J, et al. Association of serum total iron-binding capacity and its changes over time with nutritional and clinical outcomes in hemodialysis patients [J]. Am J Nephrol, 2009, 29(6): 571-581.
[26]	Xiaoyan J, Rongyi C, Xuesen C, et al. The difference of T cell phenotypes in end stage renal disease patients under different dialysis modality [J]. BMC Nephrol, 2019, 20(1): 301.

[1]	王国成, 刘雅静, 彭亚光. 北京市顺义区学龄前儿童血常规4项指标参考区间及其变化[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 187-193.
[2]	朱名超, 朱娅, 郭飞波, 黄银娥. 新型冠状病毒感染诱导冷凝集现象对血常规参数的影响[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 244-251.
[3]	郑庆发, 白建祥, 黄成文. 基于血小板和淋巴细胞计数比值的列线图模型预测腹膜透析相关腹膜炎患者治疗预后的价值[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(02): 117-124.
[4]	樊逸隽, 杨枫, 王玮, 殷鹤英, 刘俊. 喉前淋巴结转移对甲状腺乳头状癌诊疗价值的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(04): 306-310.
[5]	何燕玲, 龚代平. 肛周脓肿术后复发形成肛瘘的影响因素分析及预测模型建立[J]. 中华普通外科学文献(电子版), 2023, 17(01): 28-33.
[6]	张亚龙, 邱涛, 刘一霆, 王天宇, 孔晨阳, 喻博, 周江桥. 术前透析方式及时长对肾移植预后的影响[J]. 中华移植杂志(电子版), 2023, 17(02): 98-103.
[7]	李芳, 孙海云. 风险因素护理干预对合并失代偿性肝硬化的腹股沟疝患者Lichtenstein术围手术期应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 477-480.
[8]	罗阳燕, 王少清, 高芳, 沈艳, 张万军, 李莉. 尿毒清颗粒对腹膜透析患者残余肾功能及腹透液纤连蛋白和TGF-β1水平的作用[J]. 中华肾病研究电子杂志, 2023, 12(04): 200-204.
[9]	陈客宏. 干细胞外泌体防治腹膜透析腹膜纤维化新技术研究[J]. 中华肾病研究电子杂志, 2023, 12(03): 180-180.
[10]	于梦园, 杨立明, 朱学研, 张晓暄, 刘声茂, 谢舜昀, 倪册, 庄小花, 崔文鹏. 肠源性腹膜透析相关性腹膜炎治疗失败的危险因素：多中心回顾性研究[J]. 中华肾病研究电子杂志, 2023, 12(03): 127-133.
[11]	李玺琳, 章邱东. 帕金森病患者胃肠功能障碍特点及其风险因素分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(03): 145-149.
[12]	张赟辉, 罗军, 刘栗丽, 汪宏, 耿克明. 腹膜透析与血液透析对老年终末期肾病患者营养状况及炎症反应的影响[J]. 中华临床医师杂志(电子版), 2023, 17(04): 419-423.
[13]	金莉, 刘丽, 金程, 郑多娟, 王娟. 基于IKAP理论的护理专案改善腹膜透析患者自我感受与期望水平[J]. 中华临床医师杂志(电子版), 2022, 16(12): 1256-1261.
[14]	宋海红, 黎娉, 陈鲜霞. 子宫动脉搏动指数、外周血胎儿血红蛋白及胎盘生长因子水平与早发型子痫前期再次妊娠结局的关系[J]. 中华临床医师杂志(电子版), 2022, 16(11): 1109-1114.
[15]	蒋晨, 万新娟, 谢小东, 丁琳. 糖化血红蛋白、硫氧还蛋白、硫氧还蛋白互作蛋白与皮质性白内障的关系[J]. 中华临床医师杂志(电子版), 2022, 16(09): 914-918.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Epidemiological investigation and related factors analysis of anemia in peritoneal dialysis patients in Shanxi Province in 2020

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Epidemiological investigation and related factors analysis of anemia in peritoneal dialysis patients in Shanxi Province in 2020