Division of Nephrology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
Section of Nephrology, Department of Medicine, Università Degli Studi di Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
J Nephrol. 2024 Sep;37(7):1911-1919. doi: 10.1007/s40620-024-02062-y. Epub 2024 Aug 23.
Numerous studies have explored the role of kidney replacement therapy (KRT) in phosphorus (P) control among prevalent hemodialysis (HD) patients. However, whether the reduction of P achieved during KRT affects parathyroid hormone (PTH) levels is still a matter of debate.
We conducted a retrospective observational study on the prevalent HD population at the Division of Nephrology, University Hospital of Verona, from January to December 2022. We Included clinically stable adult patients undergoing HD for over 6 months, with multiple recorded visits during the follow-up. Demographic, clinical, laboratory, and medication data were collected. Time-varying variables were updated at each study visit. The primary outcome of interest was PTH levels. The absolute intra-HD change in P (intra-HD ∆P), defined as the difference between pre- and post-HD P levels, served as the main exposure. Multivariable adjusted linear mixed models were used to investigate the relationship between intra-HD ∆P and PTH levels.
A total of 211 patients contributed to 904 study visits. A significant and positive relationship was observed between intra-HD ∆P and pre-HD P (β = 0.76, 95% CI 0.75, 0.78, p < 0.001) and urea reduction ratio (β = 0.38, 95% CI 0.35, 0.41; p < 0.001). An increase in intra-HD ∆P was significantly and independently associated with low PTH levels (β = - 0.16, 95% CI - 0.30, -0.03; p = 0.020).
The extent of intra-HD P reduction significantly correlates with low PTH levels. Strategies focused on optimizing or enhancing depurative efficiency in KRT can exert a substantial impact on managing positive phosphorus balance and secondary hyperparathyroidism. The assessment of intra-HD P reduction may play a pivotal role in the management and follow-up of secondary hyperparathyroidism in HD patients.
许多研究探讨了肾脏替代疗法（KRT）在控制流行血液透析（HD）患者磷（P）方面的作用。然而，KRT 期间实现的 P 降低是否会影响甲状旁腺激素（PTH）水平仍然存在争议。
我们对 2022 年 1 月至 12 月在维罗纳大学医院肾脏病科进行的流行 HD 人群进行了回顾性观察研究。我们纳入了接受 HD 治疗超过 6 个月的临床稳定的成年患者，在随访期间有多次记录的就诊。收集了人口统计学、临床、实验室和药物数据。时间变量在每次研究就诊时更新。主要观察终点为 PTH 水平。作为主要暴露因素，我们采用了定义为 HD 前后 P 水平差异的 HD 内 P 绝对变化（intra-HD ∆P）。采用多变量调整线性混合模型探讨 intra-HD ∆P 与 PTH 水平之间的关系。
共有 211 名患者参与了 904 次研究就诊。观察到 intra-HD ∆P 与 pre-HD P（β=0.76，95%CI 0.75，0.78，p<0.001）和尿素清除率（β=0.38，95%CI 0.35，0.41；p<0.001）呈显著正相关。Intra-HD ∆P 的增加与低 PTH 水平显著相关（β=-0.16，95%CI -0.30，-0.03；p=0.020）。
HD 内 P 降低的程度与低 PTH 水平显著相关。专注于优化或增强 KRT 中净化效率的策略可以对管理正磷平衡和继发性甲状旁腺功能亢进症产生重大影响。HD 患者继发性甲状旁腺功能亢进症的管理和随访中，评估 HD 内 P 降低可能发挥关键作用。
