Cheng Jun, Zhang Wen, Zhao Yi, Li Xiayu, Lv Rong, Li Heng, Chen Jianghua
Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China.
Department of Nephrology, The Yuhang District First People's Hospital, Hangzhou, China.
Nutr Metab (Lond). 2021 Feb 11;18(1):19. doi: 10.1186/s12986-020-00525-0.
More studies have shown that serum calcium has a crucial role in many types of cancers. However, few studies have determined the association between serum calcium levels and renal impairment (RI) and all-cause death in Chinese patients with multiple myeloma (MM).
A total of 246 of 565 participants who were followed for > 6 months from a MM cohort at our institution were eligible for the retrospective study. A generalized additive model and smooth curve fitting were performed to investigate the cross-sectional relationship between the serum calcium level and RI at baseline. Multivariate-adjusted Cox regression models were fitted to assess the associations between baseline serum calcium levels and the onset of end-stage renal disease (ESRD) or death in patients with MM.
A total of 172 of 565 patients (30.4%) with newly diagnosed MM presented with RI. The mean duration of follow-up was 26.64 months. Twenty-one patients (8.54%) died and 28 patients (11.52%) had ESRD. In patients with a serum calcium level > 2.30 mmol/L, the serum calcium level was independently associated with the occurrence of MM-related RI. Cox regression analysis showed that baseline serum calcium levels were consistently associated with a higher risk of all-cause death in the fully adjusted model, but were not associated with the occurrence of ESRD. When patients were categorized into two groups according to baseline mean serum calcium level, deaths occurred in 13 patients (15.1%) with a mean serum calcium level > 2.44 mmol/L compared to eight patients (5.0%) with a mean serum calcium level < 2.44 mmol/L (p < 0.05); Eighteen patients (11.46%) with a mean serum calcium level < 2.44 mmol/L progressed to ESRD compared to 13 patients (11.6%) with a serum calcium level > 2.44 mmol/L (p > 0.05).
This observational study showed that there was a nonlinear relationship between the serum calcium level and the presence of RI in patients with MM. An elevated baseline calcium level predicted all-cause death, but did not predict the occurrence of ESRD in patients with MM followed for > 6 months.
越来越多的研究表明，血清钙在多种癌症中起着关键作用。然而，很少有研究确定中国多发性骨髓瘤（MM）患者血清钙水平与肾功能损害（RI）及全因死亡之间的关联。
在我们机构的一个MM队列中，对565名随访超过6个月的参与者中的246名进行了回顾性研究。采用广义相加模型和平滑曲线拟合来研究基线时血清钙水平与RI之间的横断面关系。拟合多变量调整的Cox回归模型，以评估基线血清钙水平与MM患者终末期肾病（ESRD）发作或死亡之间的关联。
565例新诊断的MM患者中有172例（30.4%）出现RI。平均随访时间为26.64个月。21例（8.54%）患者死亡，28例（11.52%）患者发生ESRD。血清钙水平>2.30 mmol/L的患者中，血清钙水平与MM相关RI的发生独立相关。Cox回归分析表明，在完全调整模型中，基线血清钙水平始终与全因死亡风险较高相关，但与ESRD的发生无关。当根据基线平均血清钙水平将患者分为两组时，平均血清钙水平>2.44 mmol/L的13例患者（15.1%）死亡，而平均血清钙水平<2.44 mmol/L的8例患者（5.0%）死亡（p<0.05）；平均血清钙水平<2.44 mmol/L的18例患者（11.46%）进展为ESRD，而血清钙水平>2.44 mmol/L的13例患者（11.6%）进展为ESRD（p>0.05）。
这项观察性研究表明，MM患者血清钙水平与RI的存在之间存在非线性关系。基线钙水平升高可预测全因死亡，但不能预测随访超过6个月的MM患者ESRD的发生。
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