The Royal Hospital, Ministry of Health, Muscat, Oman.
Arbor Research Collaborative for Health, Ann Arbor, Michigan.
Kidney360. 2020 Aug 26;1(10):1083-1090. doi: 10.34067/KID.0000772020. eCollection 2020 Oct 29.
The prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates). We report the relationship of PTH with mortality in this largest GCC cohort of patients on hemodialysis studied to date.
Data were from randomly selected national samples of hemodialysis facilities in GCC-DOPPS phases 5 and 6 (2012-2018). PTH descriptive findings and case mix-adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly selected patients on hemodialysis, respectively.
Mean patient age was 55 years (median dialysis vintage, 2.1 years). Median PTH ranged from 259 pg/ml (UAE) to 437 pg/ml (Kuwait), with 22% having PTH <150 pg/ml, 24% with PTH of 150-300 pg/ml, 34% with PTH 301-700 pg/ml, and 20% with PTH >700 pg/ml. Patients with PTH >700 pg/ml were younger; on dialysis longer; less likely to be diabetic; have urine >200 ml/d; be prescribed 3.5 mEq/L dialysate calcium; had higher mean serum creatinine and phosphate levels; lower white blood cell counts; and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A U-shaped PTH/mortality relationship was observed with more than two- and 1.5-fold higher adjusted HR of death at PTH >700 pg/ml and <300 pg/ml, respectively, compared with PTH of 301-450 pg/ml.
Secondary hyperparathyroidism is highly prevalent among GCC patients on hemodialysis, with a strong U-shaped PTH/mortality relationship seen at PTH <300 and >450 pg/ml. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.
前瞻性透析结局和实践模式研究（DOPPS）自 2012 年以来一直在所有六个海湾合作委员会（GCC）国家（巴林、科威特、阿曼、卡塔尔、沙特阿拉伯和阿拉伯联合酋长国）收集数据。我们报告了迄今为止在接受血液透析治疗的最大 GCC 患者队列中，甲状旁腺激素（PTH）与死亡率的关系。
数据来自海湾合作委员会 DOPPS 阶段 5 和 6（2012-2018 年）中随机选择的国家血液透析设施的样本。根据随机选择的 1825 名和 1422 名血液透析患者，分别进行了 PTH 描述性发现和病例混合调整后的 PTH/死亡率 Cox 回归分析。
患者平均年龄为 55 岁（中位数透析龄为 2.1 年）。中位 PTH 范围为 259pg/ml（阿联酋）至 437pg/ml（科威特），22%的患者 PTH<150pg/ml，24%的患者 PTH 为 150-300pg/ml，34%的患者 PTH 为 301-700pg/ml，20%的患者 PTH>700pg/ml。PTH>700pg/ml 的患者年龄较小；透析时间较长；糖尿病发病率较低；尿量>200ml/d；使用 3.5mEq/L 透析液钙；血清肌酐和磷酸盐水平较高；白细胞计数较低；更有可能使用西那卡塞、磷酸盐结合剂或静脉维生素 D 治疗。观察到甲状旁腺激素与死亡率之间存在 U 型关系，与 PTH 为 301-450pg/ml 相比，PTH>700pg/ml 和<300pg/ml 的死亡调整后 HR 分别高出两倍以上和 1.5 倍。
继发性甲状旁腺功能亢进症在 GCC 血液透析患者中非常普遍，在 PTH<300pg/ml 和>450pg/ml 时观察到强烈的 U 型甲状旁腺激素与死亡率关系。鼓励进一步研究以进一步了解 GCC 血液透析人群中这种甲状旁腺激素与死亡率之间的关系。
