《慢性肾脏病骨代谢与疾病的肾脏病预后质量倡议（K/DOQI）指南》：与透析患者死亡率的关联

The Kidney Disease Outcomes Quality Initiative (K/DOQI) Guideline for Bone Metabolism and Disease in CKD: association with mortality in dialysis patients.

作者信息

Noordzij Marlies, Korevaar Johanna C, Boeschoten Elisabeth W, Dekker Friedo W, Bos Willem J, Krediet Raymond T

机构信息

Department of Clinical Epidemiology, Academic Medical Center, University of Amsterdam, The Netherlands.

出版信息

Am J Kidney Dis. 2005 Nov;46(5):925-32. doi: 10.1053/j.ajkd.2005.08.013.

DOI:10.1053/j.ajkd.2005.08.013

PMID:16253734

Abstract

BACKGROUND

In 2003, the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (K/DOQI) published a guideline recommending tight control of serum calcium, phosphorus, calcium-phosphorus product (Ca x P), and intact parathyroid hormone levels in patients with chronic kidney disease. Within the context of this guideline, we explored associations of these plasma concentrations with all-cause mortality risk in incident dialysis patients in The Netherlands.

METHODS

In a large, prospective, multicenter, cohort study (Netherlands Cooperative Study on the Adequacy of Dialysis), we included 1,629 patients new on hemodialysis or peritoneal dialysis therapy between 1997 and 2004. Multivariate Cox regression models containing calcium level, phosphorus level, intact parathyroid hormone level, age, comorbidity, primary kidney disease, nutritional status, albumin level, dialysis dose, and hemoglobin level were used to examine mortality risks.

RESULTS

Mean age was 60 +/- 15 (SD) years, 61% were men, and 64% were treated with hemodialysis. In adjusted time-dependent survival analysis, all-cause mortality risk increased in hemodialysis patients by 40% (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and in peritoneal dialysis patients by 60% (HR, 1.6; 95% CI, 1.1 to 2.4) for plasma phosphorus levels greater than the target. In addition, having elevated plasma Ca x P product levels increased mortality risk by 40% (HR, 1.4; 95% CI, 1.1 to 1.8) in hemodialysis patients and 50% in peritoneal dialysis patients (HR, 1.5; 95% CI, 1.0 to 2.2). In both patient groups, no significant effects were observed for plasma levels less than the targets.

CONCLUSION

In time-dependent survival analysis, the presence of plasma phosphorus and Ca x P product concentrations greater than K/DOQI targets increased all-cause mortality risk in hemodialysis and peritoneal dialysis patients.

摘要

背景

2003年，美国国家肾脏基金会-肾脏病改善全球预后组织（K/DOQI）发布了一项指南，建议对慢性肾脏病患者的血清钙、磷、钙磷乘积（Ca×P）和全段甲状旁腺激素水平进行严格控制。在此指南背景下，我们探讨了荷兰新发透析患者中这些血浆浓度与全因死亡风险之间的关联。

方法

在一项大型、前瞻性、多中心队列研究（荷兰透析充分性合作研究）中，我们纳入了1997年至2004年间开始接受血液透析或腹膜透析治疗的1629例新患者。使用包含钙水平、磷水平、全段甲状旁腺激素水平、年龄、合并症、原发性肾脏疾病、营养状况、白蛋白水平、透析剂量和血红蛋白水平的多变量Cox回归模型来检查死亡风险。

结果

平均年龄为60±15（标准差）岁，61%为男性，64%接受血液透析治疗。在调整后的时间依赖性生存分析中，对于血浆磷水平高于目标值的患者，血液透析患者的全因死亡风险增加40%（风险比[HR]，1.4；95%置信区间[CI]，1.1至1.7），腹膜透析患者增加60%（HR，1.6；95%CI，1.1至2.4）。此外，血浆Ca×P乘积水平升高使血液透析患者的死亡风险增加40%（HR，1.4；95%CI，1.1至1.8），腹膜透析患者增加50%（HR，1.5；95%CI，1.0至2.2）。在两组患者中，血浆水平低于目标值时未观察到显著影响。