镁缺乏评分与慢性肾脏病患者的长期死亡率相关：一项前瞻性基于人群的队列研究。
Magnesium Depletion Score is Associated with Long-Term Mortality in Chronic Kidney Diseases: A Prospective Population-Based Cohort Study.
机构信息
Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China.
Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
出版信息
J Nephrol. 2023 Apr;36(3):755-765. doi: 10.1007/s40620-022-01489-5. Epub 2022 Nov 15.
BACKGROUND
Magnesium deficiency is common in patients with chronic kidney diseases (CKD) due to restricted magnesium intake and impaired magnesium reabsorption. Based on pathophysiological risk factors influencing kidney magnesium reabsorption, a magnesium depletion score (MDS) was developed. Using MDS as a novel indicator for assessing body magnesium status, we hypothesized that it was associated with clinical prognosis.
METHODS
We conducted a prospective population-based cohort study using data from the National Health and Nutrition Examination Survey 1999-2014 to explore the impact of MDS on the clinical outcomes of CKD patients. Propensity score-matched analyses were conducted to increase comparability. The primary outcome was all-cause mortality, and the secondary outcomes were cardiovascular-cause and cancer-cause mortality.
RESULTS
After propensity score matching, 3294 CKD patients were divided into 2 groups: MDS ≤ 2 (N = 1647), and MDS > 2 (N = 1647). During a median follow-up of 75 months, Kaplan-Meier analyses showed that MDS > 2 was associated with worse 5- and 10-year overall survival (78.5% vs 73.4%; 53.1% vs 43.1%, P < 0.001). After adjusting for confounding variables, MDS was found to be an independent risk factor for all-cause mortality (HR:1.34, 95% CI 1.20-1.50, P < 0.001). MDS > 2 was also associated with higher cardiovascular-cause mortality (16.2% VS 11.6%, P = 0.005). Multivariate competing risk analysis revealed that MDS > 2 was an independent risk factor (HR: 1.33, 95% CI 1.06-1.66, P = 0.012). Subgroup analyses reported that MDS > 2 increased all-cause mortality and cardiovascular-cause mortality only in patients with inadequate magnesium intake (P < 0.001, P < 0.001) but not in those with adequate intake (P = 0.068, P = 0.920).
CONCLUSIONS
A magnesium depletion score > 2 was independently associated with higher long-term cardiovascular-cause and all-cause mortality in CKD patients.
背景
由于镁摄入受限和镁重吸收受损，慢性肾脏病（CKD）患者普遍存在镁缺乏。基于影响肾脏镁重吸收的病理生理危险因素，开发了镁耗竭评分（MDS）。我们假设使用 MDS 作为评估机体镁状况的新指标，它与临床预后相关。
方法
我们利用 1999 年至 2014 年全国健康与营养调查的数据进行了一项前瞻性人群队列研究，以探讨 MDS 对 CKD 患者临床结局的影响。采用倾向评分匹配分析以提高可比性。主要结局为全因死亡率，次要结局为心血管原因和癌症原因死亡率。
结果
在倾向评分匹配后，3294 例 CKD 患者被分为 2 组：MDS≤2（n=1647）和 MDS>2（n=1647）。在中位随访 75 个月期间，Kaplan-Meier 分析表明，MDS>2 与较差的 5 年和 10 年总生存率相关（78.5%比 73.4%；53.1%比 43.1%，P<0.001）。在校正混杂变量后，MDS 被发现是全因死亡率的独立危险因素（HR：1.34，95%CI 1.20-1.50，P<0.001）。MDS>2 还与较高的心血管原因死亡率相关（16.2%比 11.6%，P=0.005）。多变量竞争风险分析显示，MDS>2 是独立的危险因素（HR：1.33，95%CI 1.06-1.66，P=0.012）。亚组分析报告，仅在镁摄入不足的患者中（P<0.001，P<0.001），MDS>2 增加全因死亡率和心血管原因死亡率，而在镁摄入充足的患者中（P=0.068，P=0.920），则无此相关性。
结论
MDS>2 与 CKD 患者的长期心血管原因和全因死亡率升高独立相关。
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