Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Wanfang Hospital, Taipei, Taiwan.
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Sci Rep. 2017 Feb 24;7(1):33. doi: 10.1038/s41598-017-00080-4.
Biomarkers of chronic kidney disease-mineral and bone disorder (CKD-MBD) correlate with morbidity and mortality in dialysis patients. However, the comparative roles of each CKD-MBD biomarker remained undetermined on long-term peritoneal dialysis (PD) patients. This retrospective study, employing a population-based database, aimed to evaluate the performance and provide the best evidence of each biomarker of CKD-MBD as predictor of all-cause mortality. Throughout the 8-year study period, total 12,116 PD patients were included in this study. Cox proportional regression and Kaplan-Meier method were used for survival analysis. For Cox regression model, baseline measurements and time-varying covariates were used for analysis. In Cox regression model using time-dependent covariates, serum calcium level of ≧9.5 mg/dL was associated with increased mortality. For phosphorus, serum levels of either ≧6.5 mg/dL or <3.5 mg/dL were associated with increased mortality. For parathyroid hormone (PTH), higher serum levels were not associated increased mortality. For alkaline phosphatase (ALP), mortality increased at levels ≧100 IU/L. Our findings suggested that the detrimental effect of ALP on survival was more consistent, while serum calcium, phosphorus and PTH may have a less prominent effect on mortality. This study provided additional information for manipulating CKD-MBD biomarkers in PD patients.
慢性肾脏病-矿物质和骨异常(CKD-MBD)的生物标志物与透析患者的发病率和死亡率相关。然而,在长期腹膜透析(PD)患者中,每种 CKD-MBD 生物标志物的相对作用仍未确定。这项回顾性研究利用基于人群的数据库,旨在评估每个 CKD-MBD 生物标志物作为全因死亡率预测因子的表现,并提供最佳证据。在整个 8 年的研究期间,共有 12116 名 PD 患者纳入本研究。采用 Cox 比例回归和 Kaplan-Meier 方法进行生存分析。对于 Cox 回归模型,使用基线测量值和时变协变量进行分析。在使用时变协变量的 Cox 回归模型中,血清钙水平≧9.5mg/dL 与死亡率增加相关。对于磷,血清水平≧6.5mg/dL 或<3.5mg/dL 与死亡率增加相关。对于甲状旁腺激素(PTH),较高的血清水平与死亡率增加无关。对于碱性磷酸酶(ALP),水平≧100IU/L 时死亡率增加。我们的研究结果表明,ALP 对生存的不利影响更一致,而血清钙、磷和 PTH 对死亡率的影响可能不太明显。这项研究为 PD 患者的 CKD-MBD 生物标志物的操纵提供了额外的信息。
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