Danese Mark D, Belozeroff Vasily, Smirnakis Karen, Rothman Kenneth J
Outcomes Insights, Inc., Newbury Park, California, USA.
Clin J Am Soc Nephrol. 2008 Sep;3(5):1423-9. doi: 10.2215/CJN.01060308. Epub 2008 Jul 2.
In 2003, the National Kidney Foundation introduced guidelines for the control of parathyroid hormone, calcium, and phosphorus in hemodialysis patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study was conducted of 22,937 incident hemodialysis patients who were identified from a large national provider between July 1, 2000, and June 30, 2002, and followed through June 30, 2004. Consistent achievement was determined (1) as the simultaneous control of multiple markers over time and (2) as the time in target for each marker during the first year of dialysis. Mortality risk was assessed with Cox proportional hazards models.
In the simultaneous control analysis, patients who achieved target for none of the markers had a 51% greater risk for death than those who achieved target for all three markers (reference group). Patients who achieved any target for any single marker had a 35 to 39% higher risk for death, and patients who achieved target for any two of the three markers had a 15 to 21% higher risk for death compared with the reference group. In the time in target analysis, patients with parathyroid hormone in target for 4 quarters had a 25% lower risk for death compared with those who did so for <or=1 quarter (reference group). Patients with calcium in target for 4 quarters had a 14% lower risk, and patients with phosphorus in target for 4 quarters had a 38% lower risk.
Consistent control of the markers of bone metabolism and disease within published targets is a strong predictor of survival in hemodialysis patients.
2003年，美国国家肾脏基金会出台了血液透析患者甲状旁腺激素、钙和磷控制指南。
设计、地点、参与者及测量方法：对22937例新进入血液透析的患者进行队列研究，这些患者于2000年7月1日至2002年6月30日期间从一家大型全国性医疗机构中识别出来，并随访至2004年6月30日。持续达标被定义为：（1）多种指标随时间的同时控制；（2）透析第一年中各指标处于目标范围内的时间。使用Cox比例风险模型评估死亡风险。
在同时控制分析中，未达到任何指标目标的患者死亡风险比达到所有三项指标目标的患者（参照组）高51%。达到任何一项单一指标目标的患者死亡风险比参照组高35%至39%，达到三项指标中任意两项指标目标的患者死亡风险比参照组高15%至21%。在达标时间分析中，甲状旁腺激素达标4个季度的患者死亡风险比达标≤1个季度的患者（参照组）低25%。钙达标4个季度的患者死亡风险低14%，磷达标4个季度的患者死亡风险低38%。
在已公布的目标范围内持续控制骨代谢和疾病指标是血液透析患者生存的有力预测指标。
