美国和日本慢性肾脏病患者血清磷酸盐及相关参数的比较研究。
A Comparative Study of Serum Phosphate and Related Parameters in Chronic Kidney Disease between the USA and Japan.
机构信息
Department of Nephrology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan,
Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
出版信息
Am J Nephrol. 2022;53(2-3):226-239. doi: 10.1159/000521386. Epub 2022 Feb 28.
INTRODUCTION
Recent studies have suggested a higher incidence of cardiovascular disease (CVD) among patients with chronic kidney disease (CKD) in the USA than in Japan. Hyperphosphatemia, a possible risk for CVD, may explain this difference; however, international differences in phosphate parameters in CKD have not been well elaborated.
METHODS
By using the baseline data from the USA and the Japanese nation-wide, multicenter, CKD cohort studies; the Chronic Renal Insufficiency Cohort Study (CRIC, N = 3,870) and the Chronic Kidney Disease-Japan Cohort Study (CKD-JAC, N = 2,632), we harmonized the measures and compared clinical parameters regarding phosphate metabolism or serum phosphate, fibroblast growth factor-23 (FGF23), and parathyroid hormone (PTH), in the cross-sectional model.
RESULTS
Multivariable linear regression analyses revealed that serum phosphate levels were significantly higher in CRIC across all levels of estimated glomerular filtration rate (eGFR) with the greatest difference being observed at lower levels of eGFR. Serum FGF23 and 25-hydroxy vitamin D (25OHD) levels were higher in CRIC, while PTH levels were higher in CKD-JAC at all levels of eGFR. Adjustments for demographics, 25OHD, medications, dietary intake or urinary excretion of phosphate, PTH, and FGF23 did not eliminate the difference in serum phosphate levels between the cohorts (0.43, 0.46, 0.54, 0.64, and 0.78 mg/dL higher in CRIC within eGFR strata of >50, 41-50, 31-40, 21-30, and ≤20 mL/min/1.73 m2, respectively). These findings were consistent when only Asian CRIC participants (N = 105) were included in the analysis.
CONCLUSION
Serum phosphate levels in CRIC were significantly higher than those of CKD-JAC across all stages of CKD, which may shed light on the international variations in phosphate parameters and thus in cardiovascular risk among CKD patients. The key mechanisms for the substantial differences in phosphate parameters need to be elucidated.
简介
最近的研究表明，美国慢性肾脏病（CKD）患者的心血管疾病（CVD）发病率高于日本。高磷血症可能是 CVD 的一个潜在风险因素，这可能可以解释这种差异；然而，CKD 中磷酸盐参数的国际差异尚未得到充分阐述。
方法
利用美国和日本全国多中心 CKD 队列研究的基线数据，即慢性肾功能不全队列研究（CRIC，N=3870）和慢性肾脏病-日本队列研究（CKD-JAC，N=2632），我们在横断面模型中对磷酸盐代谢或血清磷酸盐、成纤维细胞生长因子 23（FGF23）和甲状旁腺激素（PTH）的临床参数进行了协调和比较。
结果
多变量线性回归分析显示，在所有估计肾小球滤过率（eGFR）水平下，CRIC 的血清磷酸盐水平均显著升高，在较低的 eGFR 水平下差异最大。CRIC 中的血清 FGF23 和 25-羟维生素 D（25OHD）水平较高，而 CKD-JAC 在所有 eGFR 水平的 PTH 水平较高。调整人口统计学、25OHD、药物、磷酸盐、PTH 和 FGF23 的饮食摄入或尿排泄后，队列之间的血清磷酸盐水平差异仍然存在（eGFR 分层>50、41-50、31-40、21-30 和≤20 mL/min/1.73 m2 时，CRIC 中分别高 0.43、0.46、0.54、0.64 和 0.78 mg/dL）。当仅纳入分析中的亚洲 CRIC 参与者（N=105）时，这些发现是一致的。
结论
在所有 CKD 阶段，CRIC 的血清磷酸盐水平均明显高于 CKD-JAC，这可能揭示了 CKD 患者中磷酸盐参数和心血管风险的国际差异。需要阐明磷酸盐参数差异的关键机制。
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