Yu Yue, Diao Zongli, Wang Ying, Zhou Peiyi, Ding Rui, Liu Wenhu
Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, 95 Yong'An Road, Beijing 100050, China.
Ther Adv Endocrinol Metab. 2020 Sep 21;11:2042018820958322. doi: 10.1177/2042018820958322. eCollection 2020.
Low serum parathyroid hormone (PTH) level and secondary hyperparathyroidism (SHPT) are very common in hemodialysis patients. However, the outcomes of patients with low PTH level or SHPT have not been carefully compared. Therefore, in the present study, we compared the outcomes of hemodialysis patients with low PTH level or SHPT.
This was a multi-center, prospective, cohort study of 647 patients. The patients were recruited between 1 September 2016 and 1 January 2017 and followed until 31 December 2018. The participants were allocated to a low PTH group [serum intact PTH (iPTH) concentration < 60 pg/ml] and an SHPT group (iPTH ⩾ 600 pg/ml) according to their mean iPTH concentration across the entire observation period, and the outcomes were compared between these groups. The primary outcome was a composite outcome, which comprised all-cause mortality, non-fatal acute myocardial infarction, non-fatal acute stroke, and acute heart failure.
A total of 197 hemodialysis patients were allocated to the two groups: 87 with low PTH level and 110 with SHPT; 450 patients with time-averaged iPTH concentrations of 60-600 pg/ml were excluded. Kaplan-Meier analysis of the composite endpoint revealed a significant difference between participants with low PTH level and those with SHPT ( = 0.002). Cox multiple regression showed that participants with low PTH level had a higher incidence of the composite endpoint than those with SHPT (relative risk: 1.337, 95% confidence interval: 1.059-1.688).
Hemodialysis patients with low PTH level had a higher incidence of mortality and non-fatal cardiovascular events than those with SHPT, irrespective of whether the participants were age-matched.
低血清甲状旁腺激素（PTH）水平和继发性甲状旁腺功能亢进（SHPT）在血液透析患者中非常常见。然而，低PTH水平或SHPT患者的结局尚未得到仔细比较。因此，在本研究中，我们比较了低PTH水平或SHPT的血液透析患者的结局。
这是一项对647例患者进行的多中心、前瞻性队列研究。患者于2016年9月1日至2017年l月1日招募，并随访至2018年12月31日。根据整个观察期内的平均iPTH浓度，将参与者分为低PTH组[血清完整PTH（iPTH）浓度<60 pg/ml]和SHPT组（iPTH≥600 pg/ml），并比较两组的结局。主要结局是一个复合结局，包括全因死亡率、非致命性急性心肌梗死、非致命性急性中风和急性心力衰竭。
共有197例血液透析患者被分配到两组：87例PTH水平低，110例SHPT；450例平均iPTH浓度为60 - 600 pg/ml的患者被排除。对复合终点的Kaplan-Meier分析显示，低PTH水平参与者和SHPT参与者之间存在显著差异（P = 0.002）。Cox多元回归显示，低PTH水平参与者的复合终点发生率高于SHPT参与者（相对风险：1.337，95%置信区间：1.059 - 1.688）。
低PTH水平的血液透析患者比SHPT患者有更高的死亡率和非致命性心血管事件发生率，无论参与者是否年龄匹配。
