Division of Nephrology, Salem VA Medical Center, 1970 Roanoke Boulevard, Salem, VA 24153, USA.
Clin J Am Soc Nephrol. 2010 Mar;5(3):468-76. doi: 10.2215/CJN.06040809. Epub 2010 Jan 7.
Elevated serum calcium has been associated with increased mortality in dialysis patients, but it is unclear whether the same is true in non-dialysis-dependent (NDD) chronic kidney disease (CKD). Outcomes associated with low serum calcium are also not well-characterized.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We examined associations of baseline, time-varying, and time-averaged serum calcium with all-cause mortality in a historic prospective cohort of 1243 men with moderate and advanced NDD CKD by using Cox models.
The association of serum calcium with mortality varied according to the applied statistical models. Higher baseline calcium and time-averaged calcium were associated with higher mortality (multivariable adjusted hazard ratio (95% confidence interval): 1.31 (1.13, 1.53); P < 0.001 for a baseline calcium 1 mg/dl higher). However, in time-varying analyses, lower calcium levels were associated with increased mortality.
Higher serum calcium is associated with increased long-term mortality (as reflected by the baseline and time-averaged models), and lower serum calcium is associated with increased short-term mortality (as reflected by the time-varying models) in patients with NDD CKD. Clinical trials are warranted to determine whether maintaining normal serum calcium can improve outcomes in these patients.
血清钙升高与透析患者死亡率增加相关，但在非透析依赖（NDD）慢性肾脏病（CKD）患者中是否同样如此尚不清楚。血清钙水平低与哪些结果相关也尚未明确。
设计、设置、参与者和测量：我们使用 Cox 模型，在一项对 1243 名中重度和晚期 NDD CKD 男性的历史性前瞻性队列中，检查了基线、时变和时均血清钙与全因死亡率之间的相关性。
血清钙与死亡率的相关性因所应用的统计模型而异。较高的基线钙和时均钙与死亡率升高相关（多变量校正的危险比（95%置信区间）：1.31（1.13，1.53）；每升高 1 毫克/分升基线钙，P<0.001）。然而，在时变分析中，较低的钙水平与死亡率升高相关。
在 NDD CKD 患者中，较高的血清钙与长期死亡率增加相关（反映在基线和时均模型中），而较低的血清钙与短期死亡率增加相关（反映在时变模型中）。需要进行临床试验来确定维持正常血清钙是否可以改善这些患者的结局。
