矿物质代谢趋势：肾脏早期评估项目（KEEP）与1999 - 2004年美国国家健康与营养检查调查（NHANES）
Trends in mineral metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004.
作者信息
Vassalotti Joseph A, Uribarri Jaime, Chen Shu-Cheng, Li Suying, Wang Changchun, Collins Allan J, Calvo Mona S, Whaley-Connell Adam T, McCullough Peter A, Norris Keith C
机构信息
National Kidney Foundation, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Nephrology Box 1243, New York, NY 10029-6574, USA.
出版信息
Am J Kidney Dis. 2008 Apr;51(4 Suppl 2):S56-68. doi: 10.1053/j.ajkd.2007.12.018.
BACKGROUND
Chronic kidney disease (CKD) is associated with mineral metabolism dysregulation, cardiovascular disease, and premature mortality. No study specifically examined mineral metabolism trends in a generalizable sample of patients at increased CKD risk.
METHODS
This cross-sectional analysis from November 1, 2005, to December 31, 2006, of calcium, phosphorus, and parathyroid hormone (PTH) includes 2,646 individuals with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m(2) in the National Kidney Foundation Kidney Early Evaluation Program (KEEP), a community-based health-screening program targeting individuals 18 years and older with diabetes, hypertension, or family history of kidney disease, diabetes, or hypertension. A parallel analysis of National Health and Nutrition Examination Survey (NHANES) 1999-2004 data was performed.
RESULTS
In KEEP, as eGFR decreased from 55 to less than 60 mL/min/1.73 m(2) to less than 30 mL/min/1.73 m(2), calcium level decreased (9.55 +/- 0.47 to 9.34 +/- 0.62 mg/dL; P < 0.001), phosphorus level increased (3.70 +/- 0.59 to 4.15 +/- 0.80 mg/dL; P < 0.001), and PTH level increased (66.3 +/- 36.3 to 164 +/- 109 pg/mL; mean, 80.8 +/- 57.0 pg/mL; P < 0.001). NHANES 1999-2004 showed similar trends, with PTH values not as high. Individuals within opinion-based Kidney Disease Outcomes Quality Initiatives targets from the highest to the lowest eGFR group were as follows: calcium, 93.0% to 92.3% (KEEP) and 97.4% to 89.6% (NHANES); phosphorus, 90.4% to 90.3% (KEEP) and 91.6% to 87.1% (NHANES); and PTH, 46.1% to 31.2% (KEEP) and 56.4% to 36.1% (NHANES).
CONCLUSIONS
In a community-based CKD screening population, increased PTH level occurs early in patients with stage 3, typically with normal calcium and phosphorus levels. These findings support the importance of including PTH with calcium and phosphorus monitoring for individuals with eGFR less than 60 mL/min/1.73 m(2).
背景
慢性肾脏病（CKD）与矿物质代谢失调、心血管疾病及过早死亡相关。尚无研究专门考察具有普遍代表性的CKD风险增加患者样本中的矿物质代谢趋势。
方法
此项横断面分析纳入了2646例估算肾小球滤过率（eGFR）低于60 mL/（min·1.73 m²）的个体，时间跨度为2005年11月1日至2006年12月31日，这些个体来自美国国家肾脏基金会肾脏早期评估项目（KEEP），这是一项基于社区的健康筛查项目，目标人群为18岁及以上患有糖尿病、高血压或有肾脏疾病、糖尿病或高血压家族史的个体。同时对1999 - 2004年美国国家健康和营养检查调查（NHANES）的数据进行了平行分析。
结果
在KEEP研究中，随着eGFR从55降至低于60 mL/（min·1.73 m²）再降至低于30 mL/（min·1.73 m²），血钙水平下降（从9.55±0.47降至9.34±0.62 mg/dL；P<0.001），血磷水平升高（从3.70±0.59升至4.15±0.80 mg/dL；P<0.001），甲状旁腺激素（PTH）水平升高（从66.3±36.3升至164±109 pg/mL；平均为80.8±57.0 pg/mL；P<0.001）。1999 - 2004年的NHANES研究呈现出相似趋势，不过PTH值没那么高。基于意见的肾脏病预后质量倡议目标范围内，从最高到最低eGFR组的个体达标情况如下：血钙，KEEP组为93.0%至92.3%，NHANES组为97.4%至89.6%；血磷，KEEP组为90.4%至90.3%，NHANES组为91.6%至87.1%；PTH，KEEP组为46.1%至31.2%，NHANES组为56.4%至36.1%。
结论
在基于社区的CKD筛查人群中，3期患者早期即出现PTH水平升高，通常血钙和血磷水平正常。这些发现支持了对于eGFR低于60 mL/（min·1.73 m²）的个体，将PTH纳入血钙和血磷监测的重要性。
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