在持续不卧床腹膜透析患者中，血清 iPTH 与腹膜炎发作之间的关系。

Relationship between serum iPTH and peritonitis episodes in patients undergoing continuous ambulatory peritoneal dialysis.

机构信息

Department of Integrated Traditional and Western Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China.

出版信息

Front Endocrinol (Lausanne). 2023 Mar 27;14:1081543. doi: 10.3389/fendo.2023.1081543. eCollection 2023.

DOI:10.3389/fendo.2023.1081543

PMID:37051200

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10083419/

Abstract

BACKGROUND

Peritonitis is considered as one of the most serious complications that cause hospitalization in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). There is limited evidence on the impact of the parathyroid hormone (PTH) on the first peritoneal dialysis (PD)-associated peritonitis episode. We aimed to investigate the influence of serum intact parathyroid hormone (iPTH) on peritonitis in patients undergoing PD.

METHODS

This was a retrospective cohort study. Patients undergoing initial CAPD from a single center in China were enrolled. The baseline characteristics and clinical information were recorded. The primary outcome of interest was the occurrence of the first PD-associated peritonitis episode. Five Cox proportional hazard models were constructed in each group set. In group set 1, all participants were divided into three subgroups by tertiles of the serum concentration of iPTH; in group set 2, all participants were divided into three subgroups based on the serum concentration of iPTH with 150 pg/ml interval (<150, 150-300, and >300 pg/ml). Hazard ratios and 95% confidence intervals (CIs) were calculated for each model. The multivariate linear regression analysis elimination procedure assessed the association between the clinical characteristics at baseline and the iPTH levels. Restricted cubic spline models were constructed, and stratified analyses were also conducted.

RESULTS

A total of 582 patients undergoing initial PD (40% women; mean age, 45.1 ± 11.5 years) from a single center in China were recruited. The median follow-up duration was 25.3 months. Multivariate Cox regression analysis showed that, in the fully adjusted model, a higher serum iPTH level (tertile 3, iPTH >300 pg/ml) was significantly associated with a higher risk of PD-associated peritonitis at 3 years [tertile 3: hazard ratio (HR) = 1.53, 95%CI = 1.03-2.55, = 0.03; iPTH > 300 pg/ml: HR = 1.57, 95%CI = 1.08-2.27, = 0.02]. The hazard ratio for every 100 pg/ml increase in serum iPTH level was 1.12 (95%CI = 1.05-1.20, < 0.01) in the total cohort when treating iPTH as a continuous variable.

CONCLUSIONS

An elevated iPTH level was significantly associated with an increased risk of peritonitis in patients undergoing CAPD.

摘要

背景

腹膜炎被认为是导致持续性非卧床腹膜透析（CAPD）患者住院的最严重并发症之一。关于甲状旁腺激素（PTH）对首次腹膜透析（PD）相关腹膜炎发作的影响，证据有限。我们旨在研究血清全段甲状旁腺激素（iPTH）对 PD 患者腹膜炎的影响。

方法

这是一项回顾性队列研究。纳入了来自中国一家单中心接受初始 CAPD 的患者。记录了基线特征和临床信息。主要观察终点是首次 PD 相关腹膜炎发作。在每组中构建了五个 Cox 比例风险模型。在组 1 中，所有参与者根据 iPTH 血清浓度分为三分位组；在组 2 中，所有参与者根据 iPTH 血清浓度分为三组（<150、150-300 和>300 pg/ml）。为每个模型计算了危险比和 95%置信区间（CI）。多变量线性回归分析消除程序评估了基线时临床特征与 iPTH 水平之间的关联。构建了受限立方样条模型，并进行了分层分析。

结果

共纳入了 582 名来自中国一家单中心的接受初始 PD（40%为女性；平均年龄 45.1±11.5 岁）的患者。中位随访时间为 25.3 个月。多变量 Cox 回归分析显示，在完全调整模型中，较高的血清 iPTH 水平（三分位 3，iPTH>300 pg/ml）与 3 年内 PD 相关腹膜炎的风险显著增加相关[三分位 3：风险比（HR）=1.53，95%CI=1.03-2.55，=0.03；iPTH>300 pg/ml：HR=1.57，95%CI=1.08-2.27，=0.02]。当将 iPTH 视为连续变量时，血清 iPTH 水平每增加 100 pg/ml，总队列中发生腹膜炎的风险比为 1.12（95%CI=1.05-1.20，<0.01）。