碳酸镧对 3-4 期 CKD 患者血清钙磷颗粒的影响：一项安慰剂对照随机试验的结果。
Effect of lanthanum carbonate on serum calciprotein particles in patients with stage 3-4 CKD-results from a placebo-controlled randomized trial.
机构信息
Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
出版信息
Nephrol Dial Transplant. 2023 Feb 13;38(2):344-351. doi: 10.1093/ndt/gfac043.
BACKGROUND
Calciprotein particles (CPP) are colloidal aggregates of calcium phosphate and the mineral-binding protein fetuin-A, and are potential mediators of cardiovascular disease in chronic kidney disease (CKD). Emerging evidence suggests non-calcium-containing phosphate binders may reduce serum CPP in patients with kidney failure who require dialysis; however, it is unclear whether similar interventions are effective in patients with earlier stages of CKD.
METHODS
The IMpact of Phosphate Reduction On Vascular End-points in CKD (IMPROVE-CKD) was a multi-centre, placebo-controlled, randomized trial of lanthanum carbonate on cardiovascular markers in 278 participants with stage 3b/4 CKD. In this pre-specified exploratory analysis, primary (CPP-I) and secondary CPP (CPP-II) were measured in a sub-cohort of participants over 96 weeks. Treatment groups were compared using linear mixed-effects models and the relationship between serum CPP and pulse wave velocity (PWV) and abdominal aortic calcification (AAC) was examined.
RESULTS
A total of 253 participants had CPP data for baseline and at least one follow-up timepoint and were included in this analysis. The mean age was 62.4 ± 12.6 years, 32.0% were female and the mean estimated glomerular filtration rate (eGFR) was 26.6 ± 8.3 mL/min/1.73 m2. Baseline median serum CPP-I was 14.9 × 104 particles/mL [interquartile range (IQR) 4.6-49.3] and median CPP-II was 3.3 × 103 particles/mL (IQR 1.4-5.4). There was no significant difference between treatment groups at 96 weeks in CPP-I [22.8% (95% confidence interval -39.2, 36.4), P = 0.65] or CPP-II [-18.3% (95% confidence interval -40.0, 11.2), P = 0.20] compared with a placebo. Serum CPP were not correlated with baseline PWV or AAC, or with the progression of either marker.
CONCLUSIONS
Lanthanum carbonate was not associated with a reduction of CPP at 96 weeks when compared with a placebo in a CKD cohort.
背景
钙磷蛋白颗粒（CPP）是磷酸钙和矿物质结合蛋白胎球蛋白-A 的胶体聚集物，是慢性肾脏病（CKD）中心血管疾病的潜在介质。新出现的证据表明，非含钙的磷酸盐结合剂可能会降低需要透析的肾衰竭患者的血清 CPP；然而，在 CKD 早期阶段的患者中，类似的干预措施是否有效尚不清楚。
方法
磷还原对 CKD 血管终点的影响（IMPROVE-CKD）是一项多中心、安慰剂对照、随机临床试验，研究了碳酸镧对 278 名 CKD 3b/4 期患者心血管标志物的影响。在这项预先指定的探索性分析中，在 96 周的时间内，对亚组参与者测量了主要（CPP-I）和次要 CPP（CPP-II）。使用线性混合效应模型比较治疗组，并检查血清 CPP 与脉搏波速度（PWV）和腹主动脉钙化（AAC）之间的关系。
结果
共有 253 名参与者有基线和至少一个随访时间点的 CPP 数据，并纳入了这项分析。平均年龄为 62.4±12.6 岁，32.0%为女性，平均估计肾小球滤过率（eGFR）为 26.6±8.3mL/min/1.73m2。基线时 CPP-I 的中位数血清为 14.9×104 个颗粒/mL[四分位距（IQR）4.6-49.3]，CPP-II 的中位数为 3.3×103 个颗粒/mL（IQR 1.4-5.4）。96 周时，治疗组之间 CPP-I[22.8%（95%置信区间-39.2，36.4），P=0.65]或 CPP-II[-18.3%（95%置信区间-40.0，11.2），P=0.20]与安慰剂相比，无显著差异。与基线 PWV 或 AAC 或两种标志物的进展相比，血清 CPP 均无相关性。
结论
与安慰剂相比，在 CKD 队列中，碳酸镧在 96 周时与 CPP 降低无关。
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