Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Fukuoka Renal Clinic, Fukuoka, Japan.
Atherosclerosis. 2020 Jul;304:22-29. doi: 10.1016/j.atherosclerosis.2020.04.022. Epub 2020 May 29.
Peripheral artery disease (PAD) is mainly caused by atherosclerosis and is a critical cardiovascular complication in patients undergoing hemodialysis. Although hyperphosphatemia is a risk factor for cardiovascular events, whether serum phosphate concentration is associated with PAD remains unclear. This study was performed to clarify the relationship between serum phosphate concentration and the risk of intervention for PAD in patients undergoing hemodialysis.
In total, 3505 patients undergoing hemodialysis registered in the Q-Cohort Study were followed up for 10 years. The primary outcome was the incidence of major adverse limb events (MALE) as a surrogate endpoint of intervention for PAD. The patients were divided into quartiles according to the baseline serum phosphate concentration: Q1 (n = 886), <4.2 mg/dL; Q2 (n = 837), 4.2-4.8 mg/dL; Q3 (n = 909), 4.9-5.6 mg/dL; and Q4 (n = 873), ≥5.7 mg/dL. A multivariable-adjusted Cox proportional hazards risk model was employed to examine the association between the serum phosphate concentration and the risk of MALE.
During a median follow-up period of 8.2 years, 257 patients required intervention with MALE. The Cox proportional hazards risk model showed that the risk of MALE in Q4 was significantly higher than that in Q1 (hazard ratio, 1.81; 95% confidence interval, 1.25-2.63). Every 1-mg/dL increase in serum phosphate concentration was also significantly associated with the increased incidence of MALE (hazard ratio, 1.24; 95% confidence interval, 1.10-1.39).
An elevated serum phosphate concentration was associated with an increased risk of MALE in patients undergoing hemodialysis.
外周动脉疾病（PAD）主要由动脉粥样硬化引起，是血液透析患者的严重心血管并发症。尽管高磷血症是心血管事件的危险因素，但血清磷酸盐浓度与 PAD 的关系尚不清楚。本研究旨在阐明血清磷酸盐浓度与血液透析患者 PAD 介入风险的关系。
共有 3505 名在 Q-队列研究中登记的血液透析患者接受了 10 年的随访。主要终点是主要不良肢体事件（MALE）的发生率，作为 PAD 介入的替代终点。根据基线血清磷酸盐浓度将患者分为四组：Q1（n=886），<4.2mg/dL；Q2（n=837），4.2-4.8mg/dL；Q3（n=909），4.9-5.6mg/dL；Q4（n=873），≥5.7mg/dL。采用多变量调整 Cox 比例风险模型来检验血清磷酸盐浓度与 MALE 风险之间的关系。
在中位随访 8.2 年期间，有 257 名患者需要进行 MALE 干预。Cox 比例风险模型显示，Q4 组的 MALE 风险明显高于 Q1 组（风险比，1.81；95%置信区间，1.25-2.63）。血清磷酸盐浓度每增加 1mg/dL，MALE 的发生率也显著增加（风险比，1.24；95%置信区间，1.10-1.39）。
血清磷酸盐浓度升高与血液透析患者 MALE 发生率增加相关。
