Morooka Hikaru, Tanaka Akihito, Inaguma Daijo, Maruyama Shoichi
Division of Nephrology, Nagoya University Hospital, Nagoya, Japan.
Division of Internal Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan.
Clin Kidney J. 2021 Oct 14;15(2):328-337. doi: 10.1093/ckj/sfab207. eCollection 2022 Feb.
Hyperphosphatemia in patients undergoing dialysis is common and is associated with mortality. Recently, the link between phosphate metabolism and iron dynamics has received increasing attention. However, the association between this relationship and prognosis remains largely unexplored.
We conducted an observational study of patients who initiated dialysis in the 17 centers participating in the Aichi Cohort Study of the Prognosis in Patients Newly Initiated into Dialysis. Data were available on sex, age, use of phosphate binder, drug history, medical history and laboratory data. After excluding patients with missing values of phosphate, hemoglobin, ferritin and transferrin saturation, we used the Gaussian mixture model to divide the cohort into clusters based on phosphate, hemoglobin, logarithmic ferritin and transferrin saturation. We investigated the prognosis of patients in these clusters. The primary outcome was all-cause death. In each cluster, the prognostic impact of phosphate binder was also studied.
The study included 1175 patients with chronic kidney disease who initiated dialysis between October 2011 and September 2013. Among them, 785 were men and 390 were women, with a mean ± SD age of 67.9 ± 13.0 years. The patients were divided into three clusters, and mortality was higher in cluster c than in cluster a (P = 0.005). Moreover, the use of phosphate binders was associated with a lower risk of all-cause death in two clusters (a and c) that were characterized by older age and higher prevalence of diabetes mellitus, among other things.
We used an unsupervised machine learning method to cluster patients, using phosphate, hemoglobin and iron-related markers. In two of the clusters, the oral use of a phosphate binder might improve prognosis.
接受透析的患者中高磷血症很常见，且与死亡率相关。最近，磷代谢与铁动力学之间的联系受到越来越多的关注。然而，这种关系与预后之间的关联在很大程度上仍未得到探索。
我们对参与爱知新开始透析患者预后队列研究的17个中心中开始透析的患者进行了一项观察性研究。可获得有关性别、年龄、磷结合剂使用情况、用药史、病史和实验室数据。在排除磷、血红蛋白、铁蛋白和转铁蛋白饱和度缺失值的患者后，我们使用高斯混合模型根据磷、血红蛋白、对数铁蛋白和转铁蛋白饱和度将队列分为不同组群。我们研究了这些组群中患者的预后。主要结局是全因死亡。在每个组群中，还研究了磷结合剂的预后影响。
该研究纳入了2011年10月至2013年9月期间开始透析的1175例慢性肾脏病患者。其中，男性785例，女性390例，平均年龄±标准差为67.9±13.0岁。患者被分为三个组群，c组群的死亡率高于a组群（P = 0.005）。此外，在以年龄较大和糖尿病患病率较高等为特征的两个组群（a组和c组）中，使用磷结合剂与全因死亡风险较低相关。
我们使用无监督机器学习方法，根据磷、血红蛋白和铁相关标志物对患者进行分组。在其中两个组群中，口服磷结合剂可能改善预后。
