血清磷水平紊乱与QT间期延长之间的关联。

Association Between Disturbed Serum Phosphorus Levels and QT Interval Prolongation.

作者信息

Sasaki Sho, Fujisaki Kiichiro, Nishimura Masato, Nakano Toshiaki, Abe Masanori, Hanafusa Norio, Joki Nobuhiko

机构信息

Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.

Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.

出版信息

Kidney Int Rep. 2024 Mar 13;9(6):1792-1801. doi: 10.1016/j.ekir.2024.03.007. eCollection 2024 Jun.

DOI:10.1016/j.ekir.2024.03.007

PMID:38899225

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11184388/

Abstract

INTRODUCTION

QT interval prolongation is a risk factor for fatal arrhythmias and other cardiovascular complications. QT interval prolongation in patients on hemodialysis (HD) is not well understood. Hypocalcemia is a suspected, but poorly verified etiology in these patients, and the association between serum phosphorus levels and QT interval prolongation is unknown. We sought to determine the prevalence of QT interval prolongation in patients on HD and to verify the association between predialysis serum calcium (Ca) and phosphate (P) levels and QT interval prolongation.

METHODS

A cross-sectional study was conducted on adult patients on maintenance HD who were enrolled in the Japanese Society for Dialysis Therapy and Renal Data Registry 2019. After assessing patient characteristics, linear regression analysis was performed with predialysis serum Ca and P levels as exposures and a rate-corrected QT (QTc) interval as the outcome.

RESULTS

A total of 204,530 patients were analyzed with a mean QTc of 451.2 (standard deviation, 36.9) ms. After multivariable analysis, estimated change in QTc (coefficients; 95% confidence interval) per 1 mg/dl increase in serum Ca and P was -2.02 (-3.00 to -1.04) and 5.50 (3.92-7.09), respectively. In the restricted cubic spline curve, estimated change in QTc increased with lower values of serum Ca. The correlation between serum P and QTc showed a U-shaped curve.

CONCLUSION

Decreased serum Ca levels and decreased and increased serum P levels may be associated with QT interval prolongation in patients on maintenance HD.

摘要

引言

QT间期延长是致命性心律失常和其他心血管并发症的危险因素。血液透析（HD）患者的QT间期延长情况尚未得到充分了解。低钙血症是这些患者中一个被怀疑但未经充分证实的病因，血清磷水平与QT间期延长之间的关联尚不清楚。我们旨在确定HD患者中QT间期延长的患病率，并验证透析前血清钙（Ca）和磷（P）水平与QT间期延长之间的关联。

方法

对参加日本透析治疗学会和2019年肾脏数据登记处的维持性HD成年患者进行了一项横断面研究。在评估患者特征后，以透析前血清Ca和P水平为暴露因素，以心率校正QT（QTc）间期为结局进行线性回归分析。

结果

共分析了204,530例患者，平均QTc为451.2（标准差，36.9）ms。多变量分析后，血清Ca和P每升高1mg/dl时，QTc的估计变化（系数；95%置信区间）分别为-2.02（-3.00至-1.04）和5.50（3.92 - 7.09）。在受限立方样条曲线中，QTc的估计变化随着血清Ca值降低而增加。血清P与QTc之间的相关性呈U形曲线。