Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Internal Medicine Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Am J Transplant. 2021 Jul;21(7):2437-2447. doi: 10.1111/ajt.16457. Epub 2021 Jan 12.
Disturbances in calcium-phosphate homeostasis are common after kidney transplantation. We aimed to assess the relationship between deregulations in plasma calcium and phosphate over time and mortality and death-censored graft failure (DCGF). In this prospective cohort study, we included kidney transplant recipients with ≥2 plasma calcium and phosphate measurements. Data were analyzed using time-updated Cox regression analyses adjusted for potential confounders including time-updated kidney function. We included 2769 patients (mean age 47 ± 14 years, 42.3% female) with 138 496 plasma calcium and phosphate levels (median [IQR] 43 [31-61] measurements per patient). During follow-up of 16.3 [8.7-25.2] years, 17.2% developed DCGF and 7.9% died. Posttransplant hypercalcemia was associated with an increased risk of mortality (1.63 [1.31-2.00], p < 0.0001), but not with DCGF. Hyperphosphatemia was associated with both DCGF (2.59 [2.05-3.27], p < .0001) and mortality (3.14 [2.58-3.82], p < .0001). Only the association between hypercalcemia and mortality remained significant in sensitivity analyses censored by a simultaneous eGFR <45 mL/min/1.73 m . Hypocalcemia and hypophosphatemia were not consistently associated with either outcome. Posttransplant hypercalcemia, even in the presence of preserved kidney function, was associated with an increased mortality risk. Associations of hyperphosphatemia with DCGF and mortality may be driven by eGFR.
钙磷代谢稳态紊乱在肾移植后很常见。我们旨在评估血浆钙和磷随时间的变化与死亡率和死亡相关移植物失功（DCGF）之间的关系。在这项前瞻性队列研究中，我们纳入了至少有 2 次血浆钙和磷测量值的肾移植受者。使用时间更新的 Cox 回归分析来分析数据，该分析调整了潜在混杂因素，包括时间更新的肾功能。我们纳入了 2769 例患者（平均年龄 47 ± 14 岁，42.3%为女性），共 138496 次血浆钙和磷水平（中位数[IQR]为每个患者 43[31-61]次测量）。在 16.3[8.7-25.2]年的随访中，17.2%的患者发生了 DCGF，7.9%的患者死亡。移植后高钙血症与死亡率升高相关（1.63[1.31-2.00]，p<0.0001），但与 DCGF 无关。高磷血症与 DCGF（2.59[2.05-3.27]，p<0.0001）和死亡率（3.14[2.58-3.82]，p<0.0001）均相关。仅在同时 eGFR<45mL/min/1.73m 的敏感性分析中，校正了高钙血症与死亡率之间的关联仍然显著。低钙血症和低磷血症与任何结局均无一致关联。即使在肾功能保留的情况下，移植后高钙血症也与死亡率升高相关。高磷血症与 DCGF 和死亡率相关的原因可能是由 eGFR 驱动的。
