Kim Yunmi, Yoo Kyung Don, Kim Hyo Jin, Koh Junga, Yu Yeonsil, Kwon Young Joo, Kim Gheun-Ho, Yoo Tae-Hyun, Lee Joongyub, Jin Dong-Chan, Choi Bum Soon, Kim Yeong Hoon, Oh Kook-Hwan
Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
Department of Internal Medicine, Gangneung Dongin Hospital, Gangneung, Korea.
Kidney Res Clin Pract. 2018 Sep;37(3):266-276. doi: 10.23876/j.krcp.2018.37.3.266. Epub 2018 Sep 30.
We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients.
Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed.
Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; = 0.003).
In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.
我们研究了矿物质代谢参数与死亡率之间的关联，以确定韩国血液透析患者的最佳目标值。
纳入2012年3月至2017年6月在韩国肾脏病学会终末期肾病登记处登记的血液透析患者中，那些在入组时测量了血清钙、磷和完整甲状旁腺激素（iPTH）的患者。分析血清钙、磷和iPTH水平与全因死亡率的关联。
在21433名入组患者中，3135名（14.6%）在24.8±14.5个月的随访期间死亡。多变量调整后，校正钙处于第一五分位数的患者死亡率较低（风险比[HR]，0.84；95%置信区间[95%CI]，0.71 - 0.99；P = 0.003），而处于第五五分位数的患者与处于第三五分位数的患者相比死亡率较高（HR，1.39；95%CI，1.20 - 1.61；P < 0.001）。对于磷，只有最低五分位数与死亡率增加显著相关（HR，1.24；95%CI，1.08 - 1.43；P = 0.003）。iPTH的最低（HR，1.18；95%CI，1.02 - 1.36；P = 0.026）和最高五分位数（HR，1.24；95%CI，1.05 - 1.46；P = 0.013）与死亡率增加相关。对于根据肾脏病预后质量倡议指南实现的目标计数，未实现任何矿物质参数目标的患者死亡率高于实现所有三个目标的患者（HR，1.37；95%CI，1.12 - 1.67；P = 0.003）。
在韩国血液透析患者中，高血清钙、低磷以及高和低水平的iPTH与全因死亡率增加相关。
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