慢性肾脏病猫在开始限制磷酸盐饮食后钙稳态紊乱相关的风险因素。
Risk factors associated with disturbances of calcium homeostasis after initiation of a phosphate-restricted diet in cats with chronic kidney disease.
机构信息
Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK.
Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK.
出版信息
J Vet Intern Med. 2021 Jan;35(1):321-332. doi: 10.1111/jvim.15996. Epub 2020 Dec 24.
BACKGROUND
Dietary phosphate restriction improves survival in cats with chronic kidney disease (CKD). However, feeding a phosphate-restricted diet may disrupt calcium homeostasis leading to hypercalcemia in some cats.
OBJECTIVES
To identify risk factors associated with increasing plasma total calcium (tCa) concentration after transition to a phosphate-restricted diet and to explore its role in CKD-mineral and bone disorder (CKD-MBD) in cats.
ANIMALS
Seventy-one geriatric (≥9 years) euthyroid client-owned cats with International Renal Interest Society (IRIS) stage 2 to 3 azotemic CKD.
METHODS
Retrospective cross-sectional cohort study. Changes in plasma tCa concentration in the first 200 days of diet transition were assessed using linear regression. Binary logistic regressions were performed to identify risk factors for increasing calcium concentration. Changes in clinicopathological variables associated with CKD-MBD over time were explored using linear mixed model and generalized linear mixed model analyses.
RESULTS
Lower baseline plasma potassium (odds ratio [OR] = 1.19 per 0.1 mmol/L decrease; P = .003) and phosphate (OR = 1.15 per 0.1 mmol/L decrease; P = .01) concentrations remained independent risk factors for increasing plasma tCa concentration. Plasma creatinine (β = .069 ± .029 mg/dL; P = .02), symmetric dimethylarginine (β = .64 ± .29 μg/dL; P = .03), phosphate (β = .129 ± .062 mg/dL; P = .04), and ln[FGF23] (β = .103 ± .035 pg/mL; P = .004) concentrations had significantly increased rates of change in cats with increasing plasma tCa concentration over time.
CONCLUSION AND CLINICAL IMPORTANCE
Lower plasma potassium or phosphate concentrations or both at the time of transition of cats with CKD to a phosphate-restricted diet are independently associated with increased risk of an increase in plasma tCa concentration. Increasing plasma tCa concentration is associated with progression of CKD.
背景
限制饮食中的磷酸盐可提高患有慢性肾脏病（CKD）的猫的生存率。然而，饲喂限制磷酸盐的饮食可能会破坏钙平衡，导致一些猫发生高钙血症。
目的
确定在过渡到限制磷酸盐饮食后血浆总钙（tCa）浓度升高的相关危险因素，并探讨其在猫的 CKD-矿物质和骨异常（CKD-MBD）中的作用。
动物
71 只患有国际肾脏病学会（IRIS）分期 2 至 3 期氮质血症 CKD 的老年（≥9 岁）甲状腺功能正常的患宠猫。
方法
回顾性横断面队列研究。使用线性回归评估饮食过渡的最初 200 天内血浆 tCa 浓度的变化。使用二元逻辑回归确定钙浓度升高的危险因素。使用线性混合模型和广义线性混合模型分析来探索随时间变化与 CKD-MBD 相关的临床病理变量的变化。
结果
较低的基线血浆钾（优势比 [OR] = 每降低 0.1mmol/L 增加 1.19；P =.003）和磷酸盐（OR = 每降低 0.1mmol/L 增加 1.15；P =.01）浓度仍然是血浆 tCa 浓度升高的独立危险因素。血浆肌酐（β = 0.069 ± 0.029mg/dL；P =.02）、对称二甲基精氨酸（β = 0.64 ± 0.29μg/dL；P =.03）、磷酸盐（β = 0.129 ± 0.062mg/dL；P =.04）和 ln[FGF23]（β = 0.103 ± 0.035pg/mL；P =.004）浓度随时间的变化在血浆 tCa 浓度升高的猫中呈显著增加趋势。
结论和临床意义
患有 CKD 的猫在过渡到限制磷酸盐饮食时的血浆钾或磷酸盐浓度较低或两者都较低，与血浆 tCa 浓度升高的风险增加独立相关。血浆 tCa 浓度升高与 CKD 的进展相关。
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