Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Nephrol Dial Transplant. 2012 Jul;27(7):2899-907. doi: 10.1093/ndt/gfr747. Epub 2011 Dec 29.
Maintenance hemodialysis (MHD) patients with polycystic kidney disease (PKD) have better survival than non-PKD patients. Mineral and bone disorders (MBD) are associated with accelerated atherosclerosis and cardiovascular death in MHD patients. It is unknown whether the different MBD mortality association between MHD populations with and without PKD can explain the survival differential.
Survival models were examined to assess the association between different laboratory markers of MBD [such as serum phosphorous, parathyroid hormone (PTH), calcium and alkaline phosphatase] and mortality in a 6-year cohort of 60,089 non-PKD and 1501 PKD MHD patients.
PKD and non-PKD patients were 57±13 and 62±15 years old and included 46 and 45% women and 14 and 32% Blacks, respectively. Whereas PKD individuals with PTH 150 to <300 pg/mL (reference) had the lowest risk for mortality, the death risk was higher in patients with PTH<150 [hazard ratio (HR): 2.16 (95% confidence interval 1.53-3.06)], 300 to <600 [HR: 1.30 (0.97-1.74)] and ≥600 pg/mL [HR: 1.46 (1.02-2.08)], respectively. Similar patterns were found in non-PKD patients. Fully adjusted death HRs of time-averaged serum phosphorous increments<3.5, 5.5 to <7.5 and ≥7.5 mg/dL (reference: 3.5 to <5.5 mg/dL) for PKD patients were 2.82 (1.50-5.29), 1.40 (1.12-1.75) and 2.25 (1.57-3.22). The associations of alkaline phosphatase and calcium with mortality were similar in PKD and non-PKD patients.
Bone-mineral disorder markers exhibit similar mortality trends between PKD and non-PKD MHD patients, although some differences are observed in particular in low PTH and phosphorus ranges.
多囊肾病（PKD）患者接受维持性血液透析（MHD）的生存率优于非 PKD 患者。矿物质和骨代谢紊乱（MBD）与 MHD 患者加速动脉粥样硬化和心血管死亡相关。目前尚不清楚 MHD 人群中不同的 MBD 死亡率关联是否可以解释生存差异。
本研究使用生存模型评估了 6 年队列中的 60089 例非 PKD 和 1501 例 PKD MHD 患者中不同的 MBD 实验室标志物（如血清磷、甲状旁腺激素（PTH）、钙和碱性磷酸酶）与死亡率之间的关联。
PKD 和非 PKD 患者的年龄分别为 57±13 和 62±15 岁，分别包括 46%和 45%的女性和 14%和 32%的黑人。而 PTH 为 150 至<300 pg/mL（参考值）的 PKD 患者的死亡率最低，PTH<150 [风险比（HR）：2.16（95%置信区间 1.53-3.06）]、300 至<600 [HR：1.30（0.97-1.74）]和≥600 pg/mL [HR：1.46（1.02-2.08）]的患者死亡风险更高。非 PKD 患者也存在类似的模式。PKD 患者的时间平均血清磷增量<3.5、5.5 至<7.5 和≥7.5 mg/dL（参考值：3.5 至<5.5 mg/dL）的全调整死亡 HR 分别为 2.82（1.50-5.29）、1.40（1.12-1.75）和 2.25（1.57-3.22）。PKD 和非 PKD MHD 患者的碱性磷酸酶和钙与死亡率的相关性相似。
尽管在特定的低 PTH 和磷范围内存在一些差异，但 MBD 标志物在 PKD 和非 PKD MHD 患者中的死亡率趋势相似。
