慢性肾脏病患者尿钙排泄的相关决定因素和结局。
Determinants and Outcomes Associated With Urinary Calcium Excretion in Chronic Kidney Disease.
机构信息
Renal Division, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
出版信息
J Clin Endocrinol Metab. 2022 Jan 1;107(1):e281-e292. doi: 10.1210/clinem/dgab574.
CONTEXT
Abnormalities in calcium metabolism are common in chronic kidney disease (CKD). Diminished urinary calcium excretion may promote vascular calcification and increased urinary calcium excretion may lead to nephrolithiasis and nephrocalcinosis, conditions associated with CKD.
OBJECTIVE
To study predictors of urinary calcium excretion and its association with adverse clinical outcomes in CKD.
DESIGN, SETTING AND PATIENTS: This study assessed 3768 nondialysis participants in the Chronic Renal Insufficiency Cohort study from April 2003 to September 2008. Participants were followed up to October 2018.
EXPOSURE
Clinically plausible predictors of urinary calcium excretion and 24-h urinary calcium excretion at baseline.
MAIN OUTCOME MEASURES
Urinary calcium excretion; incident end stage kidney disease (ESKD), CKD progression [50% estimated glomerular filtration rate (eGFR) decline or incident ESKD], all-cause mortality, and atherosclerotic cardiovascular disease events.
RESULTS
eGFR was positive correlated with 24-h urinary calcium excretion. The variables most strongly associated with 24-h urinary calcium excretion in males and females were 24-h urinary sodium (β = 0.19 and 0.28, respectively), serum parathyroid hormone (β = -0.22 and -0.20, respectively), loop diuretics (β = 0.36 and 0.26, respectively), thiazide diuretics (β = -0.49 and -0.53, respectively), and self-identified black race (β = -0.23 and -0.27, respectively). Lower urinary calcium excretion was associated with greater risks of adverse outcomes, but these associations were greatly attenuated or nullified after adjustment for baseline eGFR.
CONCLUSION
Urinary calcium excretion is markedly lower in individuals with CKD compared to the general population. Determinants of urinary calcium excretion differed between sexes and levels of CKD. Associations between urinary calcium excretion and adverse clinical events were substantially confounded by eGFR.
背景
钙代谢异常在慢性肾脏病（CKD）中很常见。尿钙排泄减少可能促进血管钙化，而尿钙排泄增加则可能导致肾结石和肾钙质沉着症，这些疾病与 CKD 相关。
目的
研究 CKD 患者尿钙排泄的预测因素及其与不良临床结局的关系。
设计、地点和患者：本研究评估了 2003 年 4 月至 2008 年 9 月期间慢性肾功能不全队列研究中的 3768 名非透析参与者，随访至 2018 年 10 月。
暴露
基线时临床合理的尿钙排泄和 24 小时尿钙排泄的预测因素。
主要观察指标
尿钙排泄；终末期肾脏病（ESKD）、CKD 进展[肾小球滤过率（eGFR）下降 50%或 ESKD 新发]、全因死亡率和动脉粥样硬化性心血管疾病事件。
结果
eGFR 与 24 小时尿钙排泄呈正相关。在男性和女性中，与 24 小时尿钙排泄相关性最强的变量分别为 24 小时尿钠（β=0.19 和 0.28）、甲状旁腺激素（β=-0.22 和-0.20）、袢利尿剂（β=0.36 和 0.26）、噻嗪类利尿剂（β=-0.49 和-0.53）和自认为的黑人种族（β=-0.23 和-0.27）。尿钙排泄较低与不良结局的风险增加相关，但这些关联在调整基线 eGFR 后大大减弱或消除。
结论
与一般人群相比，CKD 患者的尿钙排泄明显较低。尿钙排泄的决定因素在性别和 CKD 水平之间存在差异。尿钙排泄与不良临床事件之间的关联在很大程度上受到 eGFR 的混杂。
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