Thongprayoon Charat, Cheungpasitporn Wisit, Mao Michael A, Harrison Andrew M, Erickson Stephen B
a Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic , Rochester , MN , USA.
b Division of Nephrology, Department of Medicine , University of Mississippi Medical Center , Jackson , MS , USA.
Hosp Pract (1995). 2019 Apr;47(2):73-79. doi: 10.1080/21548331.2019.1568719. Epub 2019 Jan 21.
Increased serum calcium-phosphate product (CaP) can result in acute kidney injury (AKI) due to tubular and interstitial calcium phosphate deposits. CaP of > 55 mg/dL is also associated with systemic calcification. However, the risk of AKI development among hospitalized patients with different admission calcium-phosphate product levels remains unclear.
All adult hospitalized patients who had both admission serum calcium and phosphate levels available from 2009 through 2013 were enrolled. Admission CaP was categorized based on its distribution into six groups (<22, 22- < 27, 27- < 32, 32- < 37, 37- < 42 and ≥42 mg/dL). The odds ratio (OR) of in-hospital mortality by admission CaP, using the CaP category of < 22 mg/dL as the reference group, was obtained by logistic regression analysis.
After excluding patients with end-stage renal disease, without serum creatinine measurement, and those who presented with AKI at the time of admission, a total of 9,864 patients were studied. In-hospital AKI occurred in 1,478 patients (15.0%). The incidence of AKI among patients with admission CaP < 22, 22 to < 27, 27 to < 32, 32 to < 37, 37 to < 42, and ≥42 mg/dL was 11.1%, 12.4%, 14.9%, 15.2%, 17.5%, and 19.9%, respectively. After adjusting for potential confounders, a CaP ≥37 mg/dL was associated with an increased risk of developing AKI with OR of 1.53 (CI 1.19-1.96) and 1.63 (CI 1.25-2.14) in patients with admission CaP 37- < 42 and ≥42, respectively. Subgroup analysis based on eGFR consistently demonstrated that CaP ≥37 mg/dL was associated with an increased risk of developing AKI in both chronic kidney disease (CKD) and non-CKD patients.
Elevated admission CaP was independently associated with an increased risk for in-hospital AKI.
血清钙磷乘积（CaP）升高可导致急性肾损伤（AKI），原因是肾小管和间质出现磷酸钙沉积。CaP>55mg/dL还与全身钙化有关。然而，不同入院时钙磷乘积水平的住院患者发生AKI的风险仍不明确。
纳入2009年至2013年期间所有入院时血清钙和磷水平均可用的成年住院患者。根据入院时CaP的分布将其分为六组（<22、22至<27、27至<32、32至<37、37至<42和≥42mg/dL）。以CaP<22mg/dL组为参照组，通过逻辑回归分析得出入院时CaP与院内死亡率的比值比（OR）。
排除终末期肾病患者、未测量血清肌酐的患者以及入院时即出现AKI的患者后，共研究了9864例患者。1478例患者（15.0%）发生院内AKI。入院时CaP<22、22至<27、27至<32、32至<37、37至<42和≥42mg/dL的患者中AKI的发生率分别为11.1%、12.4%、14.9%、15.2%、17.5%和19.9%。在对潜在混杂因素进行校正后，入院时CaP为37至<42mg/dL和≥42mg/dL的患者中，CaP≥37mg/dL与发生AKI的风险增加相关，OR分别为1.53（95%置信区间[CI]1.19-1.96）和1.63（CI 1.25-2.14）。基于估算肾小球滤过率（eGFR）的亚组分析一致表明，CaP≥37mg/dL与慢性肾脏病（CKD）和非CKD患者发生AKI的风险增加相关。
入院时CaP升高与院内AKI风险增加独立相关。
