Gosmanova Elvira O, Chen Kristina, Rejnmark Lars, Mu Fan, Swallow Elyse, Briggs Allison, Ayodele Olulade, Sherry Nicole, Ketteler Markus
Division of Nephrology and Hypertension, Albany Medical College, Albany, NY, USA.
Shire Human Genetic Therapies, Inc., a Takeda Company, Lexington, MA, USA.
Adv Ther. 2021 Apr;38(4):1876-1888. doi: 10.1007/s12325-021-01658-1. Epub 2021 Mar 9.
Chronic hypoparathyroidism, treated with conventional therapy of oral calcium supplements and active vitamin D, may increase the risk of kidney complications. This study examined risks of development and progression of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) decline in patients with chronic hypoparathyroidism.
A retrospective cohort study using a managed care claims database in the United States from January 2007 to June 2017 included patients with chronic hypoparathyroidism (excluding those receiving parathyroid hormone) and randomly selected patients without hypoparathyroidism followed for up to 5 years. Main outcome measures were (1) development of CKD, defined as new diagnosis of CKD stage 3 and higher or ≥ 2 eGFR measurements < 60 ml/min/1.73 m ≥ 3 months apart, (2) progression of CKD, defined as increase in baseline CKD stage, (3) progression to end-stage kidney disease (ESKD), and (4) eGFR decline ≥ 30% from baseline. Time-to-event analyses included Kaplan-Meier analyses with log-rank tests, and both unadjusted and adjusted Cox proportional hazards models were used to compare outcomes between cohorts.
The study included 8097 adults with and 40,485 without chronic hypoparathyroidism. In Kaplan-Meier analyses, patients with chronic hypoparathyroidism had higher risk of developing CKD and CKD progression and higher rates of eGFR decline (all P < 0.001). In multivariable Cox models adjusted for baseline characteristics, hazard ratios (95% confidence intervals [CIs]) were 2.91 (2.61-3.25) for developing CKD, 1.58 (1.23-2.01) for CKD stage progression, 2.14 (1.51-3.04) for progression to ESKD, and 2.56 (1.62-4.03) for eGFR decline (all P < 0.001) among patients with chronic hypoparathyroidism compared with those without hypoparathyroidism.
Patients with chronic hypoparathyroidism have increased risk of development and progression of CKD and eGFR decline compared with those without hypoparathyroidism. Further studies are warranted to understand underlying mechanisms for the associations between chronic hypoparathyroidism and kidney disease.
采用口服钙剂和活性维生素D的传统疗法治疗慢性甲状旁腺功能减退症，可能会增加肾脏并发症的风险。本研究调查了慢性甲状旁腺功能减退症患者发生慢性肾脏病（CKD）及其进展的风险，以及估算肾小球滤过率（eGFR）下降情况。
一项回顾性队列研究，使用美国2007年1月至2017年6月的管理式医疗理赔数据库，纳入慢性甲状旁腺功能减退症患者（不包括接受甲状旁腺激素治疗的患者），并随机选取无甲状旁腺功能减退症的患者，随访长达5年。主要结局指标为：（1）CKD的发生，定义为新诊断的CKD 3期及以上，或两次eGFR测量值＜60 ml/min/1.73 m²且间隔≥3个月；（2）CKD的进展，定义为基线CKD分期增加；（3）进展至终末期肾病（ESKD）；（4）eGFR较基线下降≥30%。事件发生时间分析包括采用对数秩检验的Kaplan-Meier分析，使用未调整和调整后的Cox比例风险模型比较队列间的结局。
该研究纳入了8097例患有慢性甲状旁腺功能减退症的成年人和40485例无此病的成年人。在Kaplan-Meier分析中，慢性甲状旁腺功能减退症患者发生CKD及CKD进展的风险更高，eGFR下降率也更高（所有P＜0.001）。在根据基线特征进行调整的多变量Cox模型中，与无甲状旁腺功能减退症的患者相比，慢性甲状旁腺功能减退症患者发生CKD的风险比（95%置信区间[CI]）为2.91（2.61 - 3.25），CKD分期进展的风险比为1.58（1.23 - 2.01），进展至ESKD的风险比为2.14（1.51 - 3.04），eGFR下降的风险比为2.56（1.62 - 4.03）（所有P＜0.001）。
与无甲状旁腺功能减退症的患者相比，慢性甲状旁腺功能减退症患者发生CKD及其进展以及eGFR下降的风险增加。有必要进一步开展研究以了解慢性甲状旁腺功能减退症与肾脏疾病之间关联的潜在机制。
