Keyzer Charlotte A, de Borst Martin H, van den Berg Else, Jahnen-Dechent Willi, Arampatzis Spyridon, Farese Stefan, Bergmann Ivo P, Floege Jürgen, Navis Gerjan, Bakker Stephan J L, van Goor Harry, Eisenberger Ute, Pasch Andreas
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands;
J Am Soc Nephrol. 2016 Jan;27(1):239-48. doi: 10.1681/ASN.2014070670. Epub 2015 Apr 29.
Calciprotein particle maturation time (T50) in serum is a novel measure of individual blood calcification propensity. To determine the clinical relevance of T50 in renal transplantation, baseline serum T50 was measured in a longitudinal cohort of 699 stable renal transplant recipients and the associations of T50 with mortality and graft failure were analyzed over a median follow-up of 3.1 years. Predictive value of T50 was assessed for patient survival with reference to traditional (Framingham) risk factors and the calcium-phosphate product. Serum magnesium, bicarbonate, albumin, and phosphate levels were the main determinants of T50, which was independent of renal function and dialysis vintage before transplant. During follow-up, 81 (12%) patients died, of which 38 (47%) died from cardiovascular causes. Furthermore, 45 (6%) patients developed graft failure. In fully adjusted models, lower T50 values were independently associated with increased all-cause mortality (hazard ratio, 1.43; 95% confidence interval, 1.11 to 1.85; P=0.006 per SD decrease) and increased cardiovascular mortality (hazard ratio, 1.55; 95% confidence interval, 1.04 to 2.29; P=0.03 per SD decrease). In addition to age, sex, and eGFR, T50 improved prognostication for all-cause mortality, whereas traditional risk factors or calcium-phosphate product did not. Lower T50 was also associated with increased graft failure risk. The associations of T50 with mortality and graft failure were confirmed in an independent replication cohort. In conclusion, reduced serum T50 was associated with increased risk of all-cause mortality, cardiovascular mortality, and graft failure and, of all tested parameters, displayed the strongest association with all-cause mortality in these transplant recipients.
血清中的钙蛋白颗粒成熟时间（T50）是个体血液钙化倾向的一种新指标。为了确定T50在肾移植中的临床相关性，我们在一个包含699名稳定肾移植受者的纵向队列中测量了基线血清T50，并在中位随访3.1年的时间里分析了T50与死亡率和移植失败之间的关联。参照传统（弗雷明汉）危险因素和钙磷乘积评估了T50对患者生存的预测价值。血清镁、碳酸氢盐、白蛋白和磷酸盐水平是T50的主要决定因素，其独立于移植前的肾功能和透析时间。随访期间，81名（12%）患者死亡，其中38名（47%）死于心血管原因。此外，45名（6%）患者发生移植失败。在完全调整模型中，较低的T50值与全因死亡率增加（风险比，1.43；95%置信区间，1.11至1.85；每标准差降低P=0.006）和心血管死亡率增加（风险比，1.55；95%置信区间，1.04至2.29；每标准差降低P=0.03）独立相关。除年龄、性别和估算肾小球滤过率外，T50改善了全因死亡率的预后，而传统危险因素或钙磷乘积则没有。较低的T50也与移植失败风险增加相关。T50与死亡率和移植失败之间的关联在一个独立的重复队列中得到证实。总之，血清T50降低与全因死亡率、心血管死亡率和移植失败风险增加相关，并且在所有测试参数中，在这些移植受者中显示出与全因死亡率的最强关联。
