慢性肾脏病3期和4期患者的血浆甲状旁腺激素水平与心血管疾病患病率：来自肾脏早期评估项目（KEEP）的分析

Plasma parathyroid hormone level and prevalent cardiovascular disease in CKD stages 3 and 4: an analysis from the Kidney Early Evaluation Program (KEEP).

作者信息

Bhuriya Rohit, Li Suying, Chen Shu-Cheng, McCullough Peter A, Bakris George L

机构信息

Department of Medicine, Chicago Medical School, North Chicago, IL, USA.

出版信息

Am J Kidney Dis. 2009 Apr;53(4 Suppl 4):S3-10. doi: 10.1053/j.ajkd.2008.11.029.

DOI:10.1053/j.ajkd.2008.11.029

PMID:19285609

Abstract

BACKGROUND

Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). Secondary hyperparathyroidism is common in patients with CKD, and its relationship to CVD is not well defined. This analysis aims to assess whether serum intact parathyroid hormone (PTH) level is an independent risk factor for CVD in patients with CKD stages 3 and 4.

METHODS

In this cross-sectional study, medical history surveys, including CVD events, were collected from 4,472 patients with stages 3 and 4 CKD identified by the National Kidney Foundation Kidney Early Evaluation Program (KEEP), which included blood pressure measurement and laboratory testing. Age, hemoglobin level, estimated glomerular filtration rate, serum phosphorus level, and serum calcium level were evaluated as continuous variables, and plasma PTH levels, by tertile: less than 35, 35 to 70, and greater than 70 pg/mL. Multivariate logistic regression was used to estimate odds ratios (ORs) of CVD predictor variables.

RESULTS

Mean age was 68.3 +/- 11.8 years. Of the study population, 68% were women, 69% were white, 6% were current smokers, 45% were obese, 46% had diabetes, and 83% had hypertension. A history of CVD was present for 1,972 (44.1%), and plasma PTH level greater than 70 pg/mL, for 2,239 (50.1%). Multivariate logistic regression showed ORs for CVD events increasing with age (OR, 1.03; P < 0.001), male sex (OR, 1.51; P < 0.001), diabetes (OR, 1.73; P < 0.001), hypertension (OR, 1.43; P < 0.001), and intact PTH level greater than 70 pg/mL (OR, 1.51; P < 0.001; reference, <35 pg/mL).

CONCLUSIONS

PTH level greater than 70 pg/mL is independently associated with CVD events in patients with CKD stages 3 and 4. No association was observed between serum phosphorus or calcium level and CVD events. These findings provide support for intact PTH testing, along with testing for other indicators of CKD mineral and bone disorders, at earlier CKD stages.

摘要

背景

心血管疾病（CVD）是慢性肾脏病（CKD）患者最常见的死亡原因。继发性甲状旁腺功能亢进在CKD患者中很常见，其与CVD的关系尚不明确。本分析旨在评估血清完整甲状旁腺激素（PTH）水平是否为3期和4期CKD患者发生CVD的独立危险因素。

方法

在这项横断面研究中，通过美国国家肾脏基金会肾脏早期评估项目（KEEP）识别出4472例3期和4期CKD患者，收集其病史调查资料，包括CVD事件，该调查还包括血压测量和实验室检测。年龄、血红蛋白水平、估计肾小球滤过率、血清磷水平和血清钙水平作为连续变量进行评估，血浆PTH水平按三分位数划分：低于35、35至70、高于70 pg/mL。采用多因素logistic回归估计CVD预测变量的比值比（OR）。

结果

平均年龄为68.3±11.8岁。在研究人群中，68%为女性，69%为白人，6%为当前吸烟者，45%为肥胖者，46%患有糖尿病，83%患有高血压。有1972例（44.1%）有CVD病史，2239例（50.1%）血浆PTH水平高于70 pg/mL。多因素logistic回归显示，CVD事件的OR随年龄增加（OR，1.03；P<0.001）、男性（OR，1.51；P<0.001）、糖尿病（OR，1.73；P<0.001）、高血压（OR，1.43；P<0.001）以及完整PTH水平高于70 pg/mL（OR，1.51；P<0.001；参照组，<35 pg/mL）而升高。