透析人群慢性肾脏病矿物质和骨异常的表型。

Phenotypes of Mineral Bone Disorder in Chronic Kidney Disease in a Dialysis Population.

机构信息

Unidad de Investigación Médica en Enfermedades Renales, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.

出版信息

Arch Med Res. 2024 Jun;55(4):103008. doi: 10.1016/j.arcmed.2024.103008. Epub 2024 Jun 1.

DOI:10.1016/j.arcmed.2024.103008

PMID:38824883

Abstract

BACKGROUND

Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is associated with clinical outcomes. It is necessary to identify the phenotype to make clinical decisions that optimize resources and follow-up.

OBJECTIVE

To determine the frequency of the CKD-MBD phenotype in dialysis patients and the associated factors.

METHODS

Cross-sectional study in 440 patients, evaluated for CKD-MBD. Phenotypes show frequency of high, low or on target levels of PTH, vitamin D and phosphorus. The most common phenotype was used for comparisons.

RESULTS

Age was 37.5 ± 15.8 years, 53% male, 28% were diabetic, 60% on peritoneal dialysis (PD), dialysis vintage was 12.0 months (IQR 3.0-34.3). High PTH was 58%, low vitamin D 82%, high phosphorus 39%, low calcium 50%, and vascular calcification 55%. The combination of high PTH and low vitamin D and high on-target phosphorus was 39%. Those with high PTH and low vitamin D were more likely to use PD (71 vs 51%; p <0.0001), had higher lipids: total cholesterol (159 vs. 152; p = 0.002) and triglycerides (137 vs. 123; p = 0.02), higher potassium (4.7 ± 0.7 vs. 4.9 ± 0.9 mg/dL; p = 0.04), and higher serum creatinine (11.9 ± 4.4 vs. 10.6 ± 3.7 mg/dL; p = 0.01). Predictors of the most common phenotypes were PD use, total cholesterol, and serum creatinine.

CONCLUSIONS

More than one third (38%) of our sample of patients had high PTH and low vitamin D with either high or normal phosphorus. Patients with these phenotypes more frequently used PD, had higher lipids and low potassium. PD use, total cholesterol and serum creatinine were significantly associated with these phenotypes.

摘要

背景

慢性肾脏病-矿物质和骨异常（CKD-MBD）与临床结局相关。有必要确定表型，以便做出优化资源和随访的临床决策。

目的

确定透析患者 CKD-MBD 表型的频率及相关因素。

方法

对 440 例接受 CKD-MBD 评估的患者进行横断面研究。表型显示 PTH、维生素 D 和磷的高水平、低水平或目标水平的频率。使用最常见的表型进行比较。

结果

年龄为 37.5±15.8 岁，53%为男性，28%为糖尿病患者，60%接受腹膜透析（PD），透析时间为 12.0 个月（IQR 3.0-34.3）。高 PTH 为 58%，低维生素 D 为 82%，高磷为 39%，低钙为 50%，血管钙化为 55%。高 PTH 伴低维生素 D 和高目标磷的组合占 39%。高 PTH 伴低维生素 D 的患者更可能使用 PD（71%比 51%；p＜0.0001），血脂更高：总胆固醇（159 比 152；p=0.002）和甘油三酯（137 比 123；p=0.02），钾更高（4.7±0.7 比 4.9±0.9 mg/dL；p=0.04），血清肌酐更高（11.9±4.4 比 10.6±3.7 mg/dL；p=0.01）。最常见表型的预测因素是 PD 使用、总胆固醇和血清肌酐。