Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041 Chengdu, China.
Nutrients. 2023 Jun 30;15(13):2980. doi: 10.3390/nu15132980.
(1) Background: it is unclear whether serum vitamin B and circulating methylmalonic acid (MMA) are related with a poor prognosis among individuals with chronic kidney disease (CKD); (2) Methods: this prospective cohort study included 2589 individuals with CKD who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004, and from 2011 to 2014, respectively. Hazard ratios (HRs) and 95% Cis for the associations of MMA and vitamin B levels with the risk of all-cause and cardiovascular disease (CVD) mortality were calculated using multivariable Cox proportional hazards regression models. Restricted cubic spline analyses were used to examine the non-linear association of MMA levels with all-cause and CVD mortality. (3) Results: among the 2589 participants, we identified 1192 all-cause deaths and 446 CVD deaths, respectively, with a median follow-up of 7.7 years. Compared with participants with MMA < 123 nmol/L, those with MMA ≥ 240 nmol/L had an increased all-cause and CVD mortality in the multivariable-adjusted model [HR (95% CI), 2.01 (1.54-2.62) and 1.76 (1.18-2.63), respectively]; (4) Conclusions: higher circulating MMA levels were found to be strongly associated with an elevated all-cause and CVD mortality among individuals with CKD, while serum vitamin B levels were not associated.
(1) 背景：血清维生素 B 和循环甲基丙二酸（MMA）水平与慢性肾脏病（CKD）患者的不良预后是否相关尚不清楚；(2) 方法：本前瞻性队列研究纳入了分别于 1999 年至 2004 年和 2011 年至 2014 年参加国家健康和营养调查（NHANES）的 2589 例 CKD 患者。使用多变量 Cox 比例风险回归模型计算 MMA 和维生素 B 水平与全因和心血管疾病（CVD）死亡率相关的风险比（HR）和 95%置信区间（CI）。限制性立方样条分析用于研究 MMA 水平与全因和 CVD 死亡率的非线性关系。(3) 结果：在 2589 名参与者中，我们分别确定了 1192 例全因死亡和 446 例 CVD 死亡，中位随访时间为 7.7 年。与 MMA<123nmol/L 的参与者相比，MMA≥240nmol/L 的参与者在多变量调整模型中全因和 CVD 死亡率增加[HR（95%CI），2.01（1.54-2.62）和 1.76（1.18-2.63）]；(4) 结论：在 CKD 患者中，较高的循环 MMA 水平与全因和 CVD 死亡率升高密切相关，而血清维生素 B 水平与死亡率无相关性。
