Universidade de São Paulo, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil.
Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brasil.
J Bras Nefrol. 2021 Apr-Jun;43(2):182-190. doi: 10.1590/2175-8239-JBN-2020-0040.
Mineral and bone disorders (MBD) are associated with higher mortality in dialysis patients. The main guidelines related to the subject, Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO), were elaborated based on published information from hemodialysis participants. The aim of our study was to evaluate the impact of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) (according to guideline ranges from KDOQI and KDIGO) on the cardiovascular mortality of peritoneal dialysis (PD) patients.
We used the BRAZPDII database, an observational multi-centric prospective study, which assessed participants on PD between December 2004 and January 2011. Amongst 9,905 participants included in this database, we analyzed 4424 participants who were on PD for at least 6 months. The appropriate confounding variables were entered into the model. Serum levels of Ca, P, and PTH were the variables of interest for the purposes of the current study.
We found a significant association between high P serum levels, categorized by KDOQI and KDIGO (P above 5.5 mg/dL), and cardiovascular survival (p < 0.01). Likewise, a compelling association was found between lower levels of PTH, categorized by guidelines (KDOQI and KDIGO - PTH less than 150 pg/mL, p < 0.01), and cardiovascular survival.
In conclusion, levels of P above and PTH below the values proposed by KDOQI and KDIGO were associated with cardiovascular mortality in PD patients.
矿物质和骨代谢紊乱（MBD）与透析患者的死亡率升高有关。与该主题相关的主要指南，肾脏病预后质量倡议（KDOQI）和肾脏病：改善全球结果（KDIGO），是基于血液透析参与者的已发表信息制定的。我们的研究目的是评估钙（Ca），磷（P）和甲状旁腺激素（PTH）（根据 KDOQI 和 KDIGO 的指南范围）对腹膜透析（PD）患者心血管死亡率的影响。
我们使用了 BRAZPDII 数据库，这是一项观察性多中心前瞻性研究，评估了 2004 年 12 月至 2011 年 1 月之间接受 PD 的参与者。在该数据库中，共纳入了 9905 名参与者，其中 4424 名参与者接受 PD 治疗时间至少为 6 个月。适当的混杂变量被纳入模型。本研究目的是分析血清 Ca，P 和 PTH 水平。
我们发现高磷血清水平（根据 KDOQI 和 KDIGO 分类，P 高于 5.5mg/dL）与心血管生存率之间存在显著相关性（p<0.01）。同样，我们还发现 PTH 水平较低（根据指南分类，KDOQI 和 KDIGO - PTH 低于 150pg/mL）与心血管生存率之间存在强烈的相关性（p<0.01）。
总之，KDOQI 和 KDIGO 提出的 P 和 PTH 值以上和以下水平与 PD 患者的心血管死亡率相关。
