Lu Yueh-An, Lee Shen-Yang, Lin Hui-Yi, Liu Yen-Chun, Kao Huang-Kai, Chen Yung-Chang, Tian Ya-Chung, Hung Cheng-Chieh, Yang Chih-Wei, Hsu Hsiang-Hao
Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2015 Dec;38(6):531-7. doi: 10.1016/j.bj.2016.01.001. Epub 2016 Jan 19.
Reconsidering when to initiate renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) has been emphasized recently. With evolving modern aged and diabetes-prone populations, conventional markers of uremia are not sufficient for determining the optimal timing for dialysis initiation. This retrospective cohort study examined the association between hyperphosphatemia and uremic patients who need RRT registration.
All patients from the department of nephrology in one tertiary medical center in northern Taiwan who had advanced CKD and estimated glomerular filtration rates <8 mL/min/1.73 m(2) from July 2009 to May 2013 were enrolled. We reviewed the medical records and collected data on demographics, comorbidities, underlying diseases, duration of nephrology care, use of phosphate binders, and laboratory results. Univariable and multivariable logistic regression models were used to identify factors associated with hemodialysis initiation decision making.
During the study period, 209 of 292 patients with advanced CKD were enrolled in hemodialysis program and 83 patients (controls) were not. Univariable analysis indicated that male sex, current smoking, diabetes mellitus, hypertension, coronary artery disease, high serum creatinine level, and high serum phosphate level were associated with initiation of hemodialysis. Multivariable analysis indicated that those with higher serum phosphate level (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.6-3.5, p = 1.4 × 10(-5)) and being in nephrology care for <12 months (OR = 0.4, 95% CI = 0.2-0.8, p = 0.016) tended to be significant markers for hemodialysis initiation.
Hyperphosphatemia, in addition to conventional laboratory markers and uremic symptoms, may be a useful marker to determine timing of hemodialysis initiation in patients with advanced CKD.
近期，慢性肾脏病（CKD）患者何时开始肾脏替代治疗（RRT）受到了重新审视。随着现代老龄化及糖尿病高发人群的不断增加，传统的尿毒症标志物已不足以确定开始透析的最佳时机。这项回顾性队列研究探讨了高磷血症与需要进行RRT登记的尿毒症患者之间的关联。
纳入2009年7月至2013年5月期间，台湾北部某三级医疗中心肾内科所有患有晚期CKD且估算肾小球滤过率<8 mL/min/1.73 m²的患者。我们查阅了病历，并收集了人口统计学、合并症、基础疾病、肾脏科护理时长、磷结合剂使用情况及实验室检查结果等数据。采用单变量和多变量逻辑回归模型来确定与开始血液透析决策相关的因素。
在研究期间，292例晚期CKD患者中有209例纳入血液透析项目，83例患者（对照组）未纳入。单变量分析表明，男性、当前吸烟、糖尿病、高血压、冠状动脉疾病、高血清肌酐水平和高血清磷水平与开始血液透析有关。多变量分析表明，血清磷水平较高者（比值比[OR]=2.4，95%置信区间[CI]=1.6 - 3.5，p = 1.4×10⁻⁵）以及接受肾脏科护理<12个月者（OR = 0.4，95% CI = 0.2 - 0.8，p = 0.016）往往是开始血液透析的重要标志物。
除了传统的实验室指标和尿毒症症状外，高磷血症可能是确定晚期CKD患者开始血液透析时机的有用标志物。
