Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay.
Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Ren Fail. 2022 Dec;44(1):1356-1367. doi: 10.1080/0886022X.2022.2107543.
Mineral and bone disorder biomarkers 'normal ranges' are controversial. The aim of the study was to evaluate the association between serum calcium (Ca), phosphate (P), intact parathyroid hormone (iPTH), and 25(OH) vitamin D levels and mortality risk, in a chronic kidney disease (CKD) grade (G) 3b-4 cohort. The Uruguayan National Renal Healthcare Program (NRHP-UY) CKD patients' cohort, included between 1 October 2004 and 1 March 2020 and followed-up until 1 March 2021, was analyzed with the Ethics Committee approval. A total of 6473 patients were analyzed: 56% men, median age 73 (65-79) years, 55% on CKD G3b. At the end of the follow-up, 2459 (37.7%) patients had died (6.4/100 patient-year). There were iPTH data on 2013 patients (younger, with lower estimated glomerular filtration rate (eGFR) and lesser comorbidities). By bivariate Cox analysis the lowest death risk was observed with mean Ca between 9.01 and 10.25 mg/dl, P between 2.76 and 4.0 mg/dl, iPTH ≤ 105 pg/ml, and 25(OH) vitamin D >10 ng/ml. The multivariate Cox regression mortality risk adjusted to age, sex, CKD etiology, diabetes, smoking, cardiovascular comorbidity, blood pressure, proteinuria, eGFR, renin-angiotensin system blockers and vitamin D treatments, serum Ca, P, iPTH, and 25(OH) vitamin D ( = 964) showed that a higher mortality risk was associated with > 4.00 mg/dl (HR 1.668, CI 95%: 1.201-2.317), iPTH >105 pg/ml (HR 1.386, CI 95%: 1.012-1.989), and 25(OH) vitamin D ≤ 10 ng/ml (HR 1.958, CI 95%: 1.238-3.098) and a lower mortality risk with 1,25(OH) vitamin D treatment (HR 0.639, CI 95%: 0.451-0.906). These data may contribute to the precise G3b-4 CKD-MBD biomarkers levels definition.
矿物质和骨代谢紊乱生物标志物的“正常范围”存在争议。本研究旨在评估慢性肾脏病（CKD）G3b-4 队列中血清钙（Ca）、磷（P）、全段甲状旁腺激素（iPTH）和 25（OH）维生素 D 水平与死亡风险之间的关系。该研究分析了 2004 年 10 月 1 日至 2020 年 3 月 1 日期间纳入的乌拉圭国家肾脏保健计划（NRHP-UY）CKD 患者队列，并在获得伦理委员会批准后进行了随访。共有 6473 名患者纳入分析，其中 56%为男性，中位年龄 73（65-79）岁，55%为 CKD G3b。随访结束时，2459 名（37.7%）患者死亡（6.4/100 患者年）。2013 名患者（年龄较轻、估算肾小球滤过率（eGFR）较低、合并症较少）有 iPTH 数据。单变量 Cox 分析显示，Ca 在 9.01-10.25mg/dl、P 在 2.76-4.0mg/dl、iPTH≤105pg/ml 和 25（OH）维生素 D＞10ng/ml 时死亡风险最低。多变量 Cox 回归死亡风险校正年龄、性别、CKD 病因、糖尿病、吸烟、心血管合并症、血压、蛋白尿、eGFR、肾素-血管紧张素系统阻滞剂和维生素 D 治疗、血清 Ca、P、iPTH 和 25（OH）维生素 D（ = 964）后显示，血清 P＞4.00mg/dl（HR 1.668，95%CI：1.201-2.317）、iPTH＞105pg/ml（HR 1.386，95%CI：1.012-1.989）和 25（OH）维生素 D≤10ng/ml（HR 1.958，95%CI：1.238-3.098）与更高的死亡率相关，而 1，25（OH）维生素 D 治疗（HR 0.639，95%CI：0.451-0.906）与更低的死亡率相关。这些数据可能有助于确定 G3b-4 CKD-MBD 生物标志物的精确水平。
