Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nutrients. 2013 Mar 22;5(3):1002-23. doi: 10.3390/nu5031002.
The survival rate of dialysis patients, as determined by risk factors such as hypertension, nutritional status, and chronic inflammation, is lower than that of the general population. In addition, disorders of bone mineral metabolism are independently related to mortality and morbidity associated with cardiovascular disease and fracture in dialysis patients. Hyperphosphatemia is an important risk factor of, not only secondary hyperparathyroidism, but also cardiovascular disease. On the other hand, the risk of death reportedly increases with an increase in adjusted serum calcium level, while calcium levels below the recommended target are not associated with a worsened outcome. Thus, the significance of target levels of serum calcium in dialysis patients is debatable. The consensus on determining optimal parathyroid function in dialysis patients, however, is yet to be established. Therefore, the contribution of phosphorus and calcium levels to prognosis is perhaps more significant. Elevated fibroblast growth factor 23 levels have also been shown to be associated with cardiovascular events and death. In this review, we examine the associations between mineral metabolic abnormalities including serum phosphorus, calcium, and parathyroid hormone and mortality in dialysis patients.
透析患者的生存率，由高血压、营养状况和慢性炎症等危险因素决定，低于一般人群。此外，矿物质代谢紊乱与透析患者心血管疾病和骨折相关的死亡率和发病率独立相关。高磷血症是继发性甲状旁腺功能亢进症的重要危险因素，也是心血管疾病的重要危险因素。另一方面，据报道，随着校正后血清钙水平的升高，死亡风险增加，而低于推荐目标的钙水平与预后恶化无关。因此，透析患者血清钙目标水平的意义存在争议。然而，确定透析患者最佳甲状旁腺功能的共识尚未达成。因此，磷和钙水平对预后的影响可能更为重要。成纤维细胞生长因子 23 水平升高也与心血管事件和死亡有关。在这篇综述中，我们检查了包括血清磷、钙和甲状旁腺激素在内的矿物质代谢异常与透析患者死亡率之间的关系。
