矿物质代谢与慢性肾脏病 2-4 期患者的结局。
Mineral metabolism and outcomes in chronic kidney disease stage 2-4 patients.
机构信息
Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
出版信息
BMC Nephrol. 2013 Jan 16;14:14. doi: 10.1186/1471-2369-14-14.
BACKGROUND
Marked hyperphosphatemia, hyperparathyroidism and 25-hydroxyvitamin D deficiency are associated with mortality in dialysis patients. Such data in chronic kidney disease stage 2-4 population are limited. It has been suggested that high-normal serum phosphate predicts worse renal and patient outcomes. The data regarding parathyroid hormone and outcomes in this population is limited. The present study examined mineral metabolism and its association with the development of end-stage renal disease and mortality in stage 2-4 chronic kidney disease patients.
METHODS
This is a prospective cohort study that included 466 non-dialysis chronic kidney disease stage 2-4 patients. Mineral parameters were obtained at the time of enrollment and the patients were followed prospectively for 25 (1-44) months or until they reached the endpoints of end-stage renal disease or mortality.
RESULTS
Hyperparathyroidism and 25-hydroxyvitamin D deficiency began to occur in the early stages of chronic kidney disease, whereas significant hyperphosphatemia only developed in the later stages. High-normal and mildly elevated serum phosphate (>4.2 mg/dL) predicted the composite outcome of end-stage renal disease or mortality after adjustments for cardiovascular risk factors, chronic kidney disease stage and other mineral parameters. Parathyroid hormone levels above the upper limit of normal (>65 pg/mL) predicted the future development of end-stage renal disease and the composite outcome of end-stage renal disease or mortality after adjustments. 25-hydroxyvitamin D deficiency (<15 ng/mL) was also associated with worse outcomes.
CONCLUSIONS
In chronic kidney disease, hyperparathyroidism developed prior to significant hyperphosphatemia confirming the presence phosphate retention early in the course of chronic kidney disease. High-normal serum phosphate and mildly elevated parathyroid hormone levels predicted worse renal and patient outcomes. This data emphasizes the need for early intervention in the care of chronic kidney disease stage 2-4 patients.
背景
在透析患者中，明显的高磷血症、甲状旁腺功能亢进症和 25-羟维生素 D 缺乏与死亡率相关。在慢性肾脏病 2-4 期人群中，此类数据有限。有人提出，高正常血清磷预示着更差的肾脏和患者预后。在该人群中，关于甲状旁腺激素与结局的数据有限。本研究旨在探讨矿物质代谢及其与 2-4 期慢性肾脏病患者发生终末期肾病(end-stage renal disease，ESRD)和死亡的关系。
方法
这是一项前瞻性队列研究，纳入了 466 例非透析慢性肾脏病 2-4 期患者。在入组时获得矿物质参数，并对患者进行前瞻性随访 25(1-44)个月或直至达到 ESRD 或死亡终点。
结果
甲状旁腺功能亢进症和 25-羟维生素 D 缺乏症在慢性肾脏病的早期阶段就已出现，而显著高磷血症仅在晚期才出现。高正常和轻度升高的血清磷(>4.2mg/dL)在调整心血管危险因素、慢性肾脏病分期和其他矿物质参数后，预测 ESRD 或死亡的复合结局。甲状旁腺激素水平高于正常上限(>65pg/mL)在调整后预测未来发生 ESRD 以及 ESRD 或死亡的复合结局。25-羟维生素 D 缺乏(<15ng/mL)也与较差的结局相关。
结论
在慢性肾脏病中，甲状旁腺功能亢进症在显著高磷血症之前发生，这证实了在慢性肾脏病病程早期就存在磷潴留。高正常血清磷和轻度升高的甲状旁腺激素水平预示着更差的肾脏和患者预后。这些数据强调了对慢性肾脏病 2-4 期患者进行早期干预的必要性。
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