高磷血症作为腹膜透析患者冠状动脉钙化进展的独立危险因素。
Hyperphosphatemia as an independent risk factor for coronary artery calcification progression in peritoneal dialysis patients.
作者信息
Shang Da, Xie Qionghong, Ge Xiaolin, Yan Huanqing, Tian Jing, Kuang Dingwei, Hao Chuan-Ming, Zhu Tongying
机构信息
Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China.
Division of Nephrology, Huashan Hospital Baoshan Branch, Fudan University, Shanghai, 200443, China.
出版信息
BMC Nephrol. 2015 Jul 18;16:107. doi: 10.1186/s12882-015-0103-8.
BACKGROUND
Coronary artery calcification (CAC) is associated with cardiovascular mortality in end-stage renal disease (ESRD) patients. The present study aimed to identify modifiable risk factors for CAC progression in peritoneal dialysis (PD) patients.
METHODS
Adult patients who received regular PD for more than 6 months and underwent a series of coronary artery calcification score (CaCS) measurements by multislice spiral computed tomography (MSCT) with an interval of ≥ 6 months were included in this observational cohort study. The demographic characteristics and clinical data, including laboratory data and adequacy of PD, were collected. Curve estimation was used to fit the straight line and obtain the slope. Binary logistic regression was performed to identify the independent risk factors for CAC progression in the PD patients, and multivariate linear regression was conducted to identify factors associated with hyperphosphatemia.
RESULTS
A total of 207 adult patients on PD (116 men, 56.0 %) with a mean age of 59.8 ± 15.9 years were recruited to this study, and 157 of them (75.8 %) received three or more CaCS assessments. The patients were divided into a slow group (n = 137) and a rapid group (n = 70) according to the linear regression slope or the average speed of development. The follow-up time was 33.0 ± 18.8 months. Multivariate logistic regression revealed that age and serum phosphate level were independent risk factors for CAC progression after adjustments. Multivariate linear regression revealed that hyperphosphatemia was associated with elevations in the transferrin and serum albumin levels and normalized protein catabolic rate (nPCR) and reductions in the hemoglobin level, residual Ccr, and PD Ccr.
CONCLUSIONS
Hyperphosphatemia is an independent risk factor for CAC progression, and the serum phosphate level may be associated with protein intake and PD adequacy. These results provide important information for the clinical management of ESRD patients.
背景
冠状动脉钙化（CAC）与终末期肾病（ESRD）患者的心血管死亡率相关。本研究旨在确定腹膜透析（PD）患者CAC进展的可改变危险因素。
方法
本观察性队列研究纳入了接受规律PD治疗超过6个月并通过多层螺旋计算机断层扫描（MSCT）进行一系列冠状动脉钙化评分（CaCS）测量（间隔≥6个月）的成年患者。收集了人口统计学特征和临床数据，包括实验室数据和PD充分性。采用曲线估计拟合直线并获得斜率。进行二元逻辑回归以确定PD患者CAC进展的独立危险因素，并进行多元线性回归以确定与高磷血症相关的因素。
结果
本研究共纳入207例接受PD治疗的成年患者（116例男性，占56.0%），平均年龄为59.8±15.9岁，其中157例（75.8%）接受了三次或更多次CaCS评估。根据线性回归斜率或平均发展速度将患者分为缓慢进展组（n = 137）和快速进展组（n = 70）。随访时间为33.0±18.8个月。多因素逻辑回归显示，调整后年龄和血清磷水平是CAC进展的独立危险因素。多因素线性回归显示，高磷血症与转铁蛋白、血清白蛋白水平及标准化蛋白分解代谢率（nPCR）升高以及血红蛋白水平、残余肌酐清除率（Ccr）和PD Ccr降低有关。
结论
高磷血症是CAC进展的独立危险因素，血清磷水平可能与蛋白质摄入和PD充分性有关。这些结果为ESRD患者的临床管理提供了重要信息。
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