急性肾损伤中钙稳态的调节：一项前瞻性观察研究。

Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study.

作者信息

Singh Narinder Pal, Panwar Vikrant, Aggarwal Neeru P, Chhabra Satish K, Gupta Anish K, Ganguli Anirban

机构信息

Faculty of Medicine and Health Sciences, SGT Medical College Hospital and Research Institute, Gurugram, Haryana, India.

Department of Gastroenterology, Artemis Institute of Health Sciences, Gurugram, Haryana, India.

出版信息

Indian J Crit Care Med. 2022 Mar;26(3):302-306. doi: 10.5005/jp-journals-10071-24124.

DOI:10.5005/jp-journals-10071-24124

PMID:35519919

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9015928/

Abstract

BACKGROUND

Maintaining homeostasis is an integral part of all physiological processes both in health and disease including critically ill patients and may impact clinical outcomes. The present study was designed to assess prevalence of serum calcium, phosphate, vitamin-D3, FGF-23, and PTH levels abnormalities in AKI.

PATIENTS AND METHODS

Single-center, prospective, observational study in a tertiary care hospital. Patients meeting KDIGO criteria for AKI were included. Paired blood samples were drawn from eligible patients-first sample within 24 hours of AKI diagnosis and second after 5 days or at time of hospital discharge, whichever was earlier for measuring serum calcium (albumin corrected), phosphate, PTH, 25(OH)Vit-D, and FGF-23 levels. Clinical outcomes analyzed included survival status, utilization of RRT, and hospital stay.

RESULTS

Of the 50 patients with AKI, about three-fourths were males. Mean age of the participants was 57.32 ± 11.47 years. Around half of patients had hypocalcemia and four-fifths had low serum phosphate. Nearly 82% had low 25(OH)Vit-D and 52% cases had high PTH level. Patients who underwent RRT had numerically higher but not significant serum calcium and PTH levels. FGF-23 levels (pg/mL) were significantly higher in patients on RRT (81.70 ± 17.30 vs non-RRT, 72.43 ± 20.27, = 0.049), nonsurvivors (87.96 ± 18.82 vs survivors 57.11 ± 15.19, = 0.045), and those hospitalized for time of stay above median (109.67 ± 26.97 vs below median 70.27 ± 20.43, = 0.046). Among all the bone and mineral parameters analyzed high FGF23 levels were consistently linked with poor clinical outcomes in AKI.

CONCLUSION

The present study found high prevalence of calcium and phosphate disorders in AKI with dysregulated phosphate homeostasis as evidenced from elevated FGF-23 levels linked with morbidity and mortality in AKI.

HOW TO CITE THIS ARTICLE

Singh NP, Panwar V, Aggarwal NP, Chhabra SK, Gupta AK, Ganguli A. Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study. Indian J Crit Care Med 2022;26(3):302-306.

摘要

背景

维持体内平衡是健康和疾病（包括危重症患者）所有生理过程的一个组成部分，可能会影响临床结局。本研究旨在评估急性肾损伤（AKI）患者血清钙、磷、维生素D3、成纤维细胞生长因子23（FGF-23）和甲状旁腺激素（PTH）水平异常的发生率。

患者与方法

在一家三级医疗中心进行的单中心、前瞻性观察性研究。纳入符合KDIGO急性肾损伤标准的患者。从符合条件的患者中采集配对血样——第一份血样在AKI诊断后24小时内采集，第二份血样在5天后或出院时采集，以较早者为准，用于检测血清钙（校正白蛋白后）、磷、PTH、25（OH）维生素D和FGF-23水平。分析的临床结局包括生存状态、肾脏替代治疗（RRT）的使用情况和住院时间。

结果

在50例AKI患者中，约四分之三为男性。参与者的平均年龄为57.32±11.47岁。约一半患者有低钙血症，五分之四有低血磷。近82%患者25（OH）维生素D水平低，52%患者PTH水平高。接受RRT的患者血清钙和PTH水平在数值上较高，但无统计学意义。接受RRT的患者FGF-23水平（pg/mL）显著更高（81.70±17.30 vs未接受RRT者，72.43±20.27，P = 0.049），非幸存者（87.96±18.82 vs幸存者57.11±15.19，P = 0.045），以及住院时间高于中位数的患者（109.67±26.97 vs低于中位数者70.27±20.43，P = 0.046）。在所有分析的骨和矿物质参数中，高FGF23水平始终与AKI患者不良临床结局相关。