目的 探讨终末期肾病(end-stage kidney disease,ESKD)血液透析伴心肾贫血综合征(cardiorenal anemia syndrome,CRAS)患者的临床特征及预后影响因素。 方法 回顾性收集2012年8月─2021年8月苏北人民医院肾脏内科住院的ESKD血液透析伴CRAS患者基线人口学和临床资料。根据入院时左心室射血分数(left ventricular ejection fraction,LVEF)水平将患者分为LVEF≤40%组(47例)、41%≤LVEF≤49%组(81例)、LVEF≥50%组(258例)，比较3组基线资料的差异。随访终点为患者死亡或截至2022年7月31日。采用COX回归模型分析影响ESKD血液透析伴CRAS患者全因死亡风险的因素。通过广义相加模型平滑曲线拟合及多因素COX回归模型分析LVEF水平与患者全因死亡风险的关系。 结果 纳入386例ESKD血液透析伴CRAS患者，中位年龄58(46，70)岁，男性252例(65.28%)。中位随访32(17，52)月，164例(42.49%)患者死亡。多因素COX回归分析结果显示年龄(HR=1.049，95% CI:1.033～1.064,P＜0.001)、透析龄(HR=1.007，95% CI：1.002～1.011,P =0.004)、脑梗死(HR=1.748，95% CI：1.087～2.812,P=0.021)、纽约心脏病学会(New York Heart Association,NYHA)心功能分级每升高I级(HR=1.455，95% CI：1.045～2.024,P=0.026)、LVEF(HR=0.695，95% CI：0.579～0.836,P=0.001)是ESKD血液透析伴CRAS患者全因死亡风险的独立影响因素。广义相加模型平滑曲线拟合结果表明LVEF水平与患者发生全因死亡风险的变化趋势呈线性相关(对数似然比检验，P=0.043)。 结论 LVEF水平是ESKD血液透析伴CRAS患者全因死亡的独立保护因素，提高对LVEF水平的关注和处理可能对改善患者预后具有重要作用。
Objective To investigate clinical characteristics and prognosis of the end-stage kidney disease (ESKD) patients undergoing hemodialysis and complicated with cardiorenal anemia syndrome (CRAS). Methods This was a retrospective cohort study. We recruited the baseline demographic and clinical data of the ESKD patients undergoing hemodialysis patients and complicated with CRAS admitted to the Hospital from August 2012 to August 2021. According to the left ventricular ejection fraction (LVEF) at baseline, they were divided into LVEF ≤40% group, LVEF ≥41% ～≤49% group, and LVEF ≥50% group. The baseline data were compared among the three groups. They were followed up until July 31, 2022 or death. Cox regression model was used to analyze the risk factors for all-cause mortality of the patients. The relationship between LVEF and all-cause mortality risk was analyzed by generalized additive model smoothing curve fitting and multivariate Cox regression model. Results A total of 386 ESKD hemodialysis patients with CRAS were included in this study, with a median age of 58 (46，70) years old and 252 males (65.28%). During the follow-up interval [median 32(17，52) months], 164 patients (42.49%) died. Multivariate Cox regression showed that age (HR=1.049, 95% CI: 1.033～1.064, P＜0.001), dialysis age (HR=1.007, 95% CI: 1.002～1.011, P=0.004), cerebral infarction (HR=1.748, 95% CI:1.087～2.812, P=0.021), New York Heart Association (NYHA) heart functional grade (HR=1.455, 95% CI: 1.045～2.024, P=0.026), and LVEF (HR=0.695, 95% CI: 0.579～0.836, P=0.001) were the independent predictors for all-cause mortality in ESKD hemodialysis patients with CRAS. Generalized additive model smoothing curve fitting model showed that LVEF level was linearly correlated with the mortality risk trend of the patients (log-likelihood ratio test, P=0.043). Conclusions LVEF is an independent protective factor for mortality risk in ESKD hemodialysis patients with CRAS. Early diagnosis and management of lower LVEF is therefore essential to prognosis of these patients.
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