Analysis Of Characteristics Of Patients With Chronic Kidney Disease And Anemia And Meta-analysis Of Efficacy And Safety Of Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors

Objective: To investigate the clinical characteristics of patients with chronic kidney disease and the influencing factors of patients with renal anemia,and to analyze the efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitors in nondialysis and dialysis patients with renal anemia.Methods:Part Ⅰ: Analysis of the characteristics of patients with chronic kidney disease and anemia The medical records of cases with chronic kidney disease discharged from the department of nephrology of a tertiary hospital from January 2017 to October 2020 were collected and analyzed retrospectively.According to KDIGO proposed chronic kidney disease staging criteria,the subjects were divided into CKD stage 3,stage 4 and stage 5,and the etiology and composition were analyzed;according to whether renal anemia was complicated or not,the subjects were divided into non-anemia group and anemia group,the differences between groups were compared to explore the related factors affecting renal anemia.SPSS26.0 software was used for statistical processing.Part Ⅱ: Meta-analysis of efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitor in patients with renal anemiaThe PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP databases were searched for the eligible studies of hypoxia-inducible factor prolyl hydroxylase inhibitors in the treatment of renal anemia from inception to December 2020.Screen the studies according to the standardized criteria,and extract the required data.The results were pooled by Stata15.1 software.Results:Part Ⅰ: Among the 342 cases,there were 58 cases in stage 3,115 in stage 4 and 169 in stage 5,216 males and 126 females.In etiological analysis,diabetic nephropathy was the most common(21.93%),followed by chronic glomerulonephritis(5.26%)and hypertensive nephropathy(3.80%).In basic disease statistics,hypertension was the most common(89.18%),followed by diabetes(47.37%)and hyperuricemia(21.35%).Among the complications,anemia was the most common(75.44%),followed by secondary hyperparathyroidism(19.88%)and renal osteopathy(9.06%).The analysis of influencing factors of anemia showed that the age,parathyroid hormone(PTH),percentage of neutrophils(NEU),red blood cell distribution width(RDW),serum urea(UREA),serum creatinine(CREA),cystatin C(Cys C),serum high density lipoprotein(HDL-C),serum phosphorus(P)and serum potassium(K)in the anemia group were higher than those in the non-anemia group,while the BMI,white blood cell(WBC),lymphocyte percentage(LY%),lymphocyte absolute value(LY#),monocyte absolute value(MO#),red blood cell(RBC),hemoglobin(Hb),hematocrit(HCT),mean corpuscular hemoglobin concentration(MCHC),plateletcrit(PCT),total protein(TP),serum albumin(ALB),serum triglyceride(TG),serum calcium(CA)and total blood carbon dioxide(CO2)in the anemia group were lower than those in the non-anemia group,the difference was statistically significant(P < 0.05).The analysis of risk factors for anemia showed that age,increased cystatin C levels and women were the risk factors for renal anemia(P < 0.05).Part Ⅱ: A total of 21 articles,24 studies were included.10 studies aimed at 1120 nondialysis patients;compared with placebo group,HIF-PHIs group significantly increased hemoglobin,transferrin,total iron-binding capacity,significantly decreased hepcidin,transferrin saturation,ferritin levels,and significantly increased drug-related adverse events and hypertension,significantly decreased the incidence of upper respiratory tract infection.14 studies aimed at 1887 dialysis patients;compared with the control group,the HIF-PHIs group significantly increased hemoglobin,transferrin,total iron-binding capacity,serum iron levels,significantly decreased the levels of hepcidin and ferritin,and there was no significant difference in the incidence of adverse events.Conclusion:1.Among the causes of CKD,diabetic nephropathy is the most common,followed by chronic glomerulonephritis and hypertensive nephropathy.Among the basic diseases of CKD patients,hypertension is the most common,followed by diabetes and hyperuricemia.Among the complications of CKD,renal anemia is the most common,followed by secondary hyperparathyroidism and renal osteopathy.In cases with anemia,the levels of parathyroid hormone(PTH),percentage of neutrophils(NEU),red blood cell distribution width(RDW),serum urea(UREA),serum creatinine(CREA),cystatin C(Cys C),serum high density lipoprotein(HDL-C),serum phosphorus(P)and serum potassium(K)are significantly increased,while BMI,white blood cell(WBC),lymphocyte percentage(LY%),lymphocyte absolute value(LY#),monocyte absolute value(MO#),red blood cell(RBC),hemoglobin(Hb),hematocrit(HCT),mean corpuscular hemoglobin concentration(MCHC),plateletcrit(PCT),total protein(TP),serum albumin(ALB),serum triglyceride(TG),serum calcium(CA)and total blood carbon dioxide(CO2)are significantly decreased.Age,increase of Cys C and female are the risk factors for anemia.2.Hypoxia-inducible factor prolyl hydroxylase inhibitors have significant effects on increasing hemoglobin and increasing iron utilization in patients with non-dialysis and dialysis renal anemia,and have fewer adverse events and higher safety.