Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Endocrinol (Lausanne). 2022 May 13;13:869330. doi: 10.3389/fendo.2022.869330. eCollection 2022.
Low serum parathyroid hormone (PTH) and secondary hyperparathyroidism (SHPT) are very common in patients undergoing hemodialysis. However, it remains unclear which of these has a lower mortality.
In this study, we compared outcomes between hemodialysis patients with low PTH and those with SHPT.
This was a multi-center, retrospective, matched cohort study. Median intact PTH (iPTH) was used as the cutoff for allocating participants to low PTH (iPTH<100 pg/mL) and SHPT groups (iPTH ≥600 pg/mL). Sex, diabetes, age, and dialysis vintage were matched between the groups. The primary outcome was all-cause death at 72 months.
The study cohort comprised 2282 patients (1166 in each study group). Prior to matching, the primary outcome occurred in 429/1166 patients (36.79%) in the low PTH group and in 284/1116 (25.45%) in the SHPT group. There were no significant differences in all-cause death between the groups according to multivariable Cox regression (P=0.423). The hazard ratio for low PTH versus SHPT was 1.08 (95% confidence interval, 0.90-1.30). Propensity matching created 619 pairs of patients. Baseline characteristics, including age, sex, diabetes, and dialysis vintage were comparable between the groups. The primary outcome occurred in 195/619 patients (31.50%) in the low PTH group and in 193/619 (31.18%) in the SHPT group. There were no significant differences in all-cause death between the groups according to multivariable Cox regression (P=0.43). The adjusted hazard ratio for low PTH versus SHPT was 1.10 (95% confidence interval, 0.87-1.39).
Hemodialysis patients with low PTH have similar all-cause death rates to the rates for those with SHPT.
在接受血液透析的患者中，低血清甲状旁腺激素（PTH）和继发性甲状旁腺功能亢进症（SHPT）非常常见。然而，哪种情况的死亡率更低仍不清楚。
本研究比较了低 PTH 与 SHPT 血液透析患者的结局。
这是一项多中心、回顾性、匹配队列研究。以中位数完整甲状旁腺激素（iPTH）作为分界点，将参与者分为低 PTH（iPTH＜100 pg/mL）和 SHPT 组（iPTH≥600 pg/mL）。两组间进行性别、糖尿病、年龄和透析龄匹配。主要结局为 72 个月时的全因死亡。
本研究队列纳入 2282 例患者（每组 1166 例）。在匹配之前，低 PTH 组 1166 例患者中有 429 例（36.79%）和 SHPT 组 1116 例患者中有 284 例（25.45%）发生主要结局。多变量 Cox 回归分析显示两组间全因死亡率无显著差异（P=0.423）。低 PTH 组与 SHPT 组的危险比为 1.08（95%置信区间，0.90-1.30）。倾向评分匹配后产生了 619 对患者。两组间年龄、性别、糖尿病和透析龄等基线特征无显著差异。低 PTH 组 619 例患者中有 195 例（31.50%）和 SHPT 组 619 例患者中有 193 例（31.18%）发生主要结局。多变量 Cox 回归分析显示两组间全因死亡率无显著差异（P=0.43）。低 PTH 组与 SHPT 组的调整危险比为 1.10（95%置信区间，0.87-1.39）。
低 PTH 的血液透析患者的全因死亡率与 SHPT 患者相似。
