Fouque Denis, Roth Hubert, Darné Bernadette, Bouchet Jean-Louis, Daugas Eric, Drüeke Tilman B, Hannedouche Thierry, Jean Guillaume, London Gérard M
Department of Nephrology, CH Lyon Sud, Univ Lyon, Lyon, France.
Department of Nephrology, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Pôle Recherche CHU-Grenoble, Inserm U1055-Bioénergétique, Université J. Fourier, Grenoble, France.
Clin Kidney J. 2018 Oct;11(5):710-719. doi: 10.1093/ckj/sfy015. Epub 2018 Mar 15.
The aim of the third French Phosphorus and Calcium Observatory (Photo-Graphe 3) was to assess the achievement of international Kidney Disease: Improving Global Outcomes (KDIGO) recommendations on optimal serum phosphate, calcium and parathyroid hormone (PTH) levels and possible associations with mortality in patients with chronic kidney disease (CKD).
This was a prospective, observational study conducted with nephrologists in France who were selected using a clustering approach. Adult patients with non-dialysis Stage 4 or 5 CKD and no kidney graft history were eligible. Data about clinical events, serum biochemistry and treatment were collected every 6 months for 2.5 years and 12 months thereafter. The Kaplan-Meier method was used for survival analysis and Cox proportional hazards model for identification of factors associated with survival.
Overall, 566 CKD Stage 4 patients (men, 56%) and 153 CKD Stage 5 patients (men, 62%) were included. In Stage 4, only 14-15% patients achieved the three main 2009 KDIGO targets during the first 2 years and 22% at 2.5 years. In Stage 5 patients, the proportion remained <6% throughout. The percentages of patients achieving the three main 2017 KDIGO targets were slightly higher at each time point. Overall, 14% of Stage 4 and 10% of Stage 5 patients died in the observation period. Only age and haemoglobin level were significantly associated with risk of all-cause mortality.
Few CKD patients achieved KDIGO mineral targets. Increased mortality risk was linked to older age and lower haemoglobin level, but not to serum calcium, phosphate or PTH targets.
第三届法国磷与钙观察站（Photo-Graphe 3）的目的是评估国际肾脏病改善全球预后（KDIGO）关于慢性肾脏病（CKD）患者最佳血清磷、钙和甲状旁腺激素（PTH）水平的建议的达成情况，以及与死亡率的可能关联。
这是一项前瞻性观察性研究，在法国采用聚类方法选择肾脏病专家参与。符合条件的为非透析的4期或5期CKD成年患者且无肾移植史。在2.5年中每6个月收集一次有关临床事件、血清生化和治疗的数据，此后每12个月收集一次。采用Kaplan-Meier方法进行生存分析，采用Cox比例风险模型识别与生存相关的因素。
共纳入566例CKD 4期患者（男性占56%）和153例CKD 5期患者（男性占62%）。在4期，仅14%-15%的患者在最初2年内达到了2009年KDIGO的三个主要目标，2.5年时为22%。在5期患者中，该比例始终低于6%。在每个时间点，达到2017年KDIGO三个主要目标的患者百分比略高。总体而言，14%的4期患者和10%的5期患者在观察期内死亡。仅年龄和血红蛋白水平与全因死亡风险显著相关。
很少有CKD患者达到KDIGO矿物质目标。死亡风险增加与年龄较大和血红蛋白水平较低有关，但与血清钙、磷或PTH目标无关。
