Aquino Hugo B S, Canziani Maria Eugenia F, Barra Ana Beatriz L, Roque-da-Silva Ana Paula, Strogoff-de-Matos Jorge Paulo, Dalboni Maria Aparecida, Moyses Rosa M A, Elias Rosilene M
Universidade Nove de Julho (UNINOVE), Sao Paulo, (SP), Brazil.
Departamento de Medicina, Divisão de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil.
Int Urol Nephrol. 2025 Feb;57(2):545-551. doi: 10.1007/s11255-024-04188-1. Epub 2024 Sep 2.
Parathyroid hormone (PTH) is merit as a risk factor for mortality in patients with chronic kidney disease in prevalent hemodialysis patients in a U shape. Most studies, however, do not focus on incident patients and those who died within the first 90 days of therapy. We evaluated PTH as a risk factor for mortality in a large cohort population in Brazil.
This is an observational cohort study that included 4317 adult patients who initiated hemodialysis between July 1st, 2012 and June 30, 2017. The main outcome was all-cause mortality. Fine-gray sub-distribution hazard models were used to evaluate survival in the presence of a competing event (kidney transplant).
Median PTH levels of 252 (118, 479) pg/mL. There were 331 deaths during the first 90 days of therapy (6.7%), 430 in a 1-year follow-up (10.7%) and 1282 (32%) during the 5-year study period. Deaths according to PTH < 150, 150-600 and > 600 pg/mL corresponded to 38.1%, 33.0% and 28.5%, respectively (p < 0.001). In an adjusted model, patients who started dialysis with PTH < 150 pg/mL had a higher mortality risk within the first 90 days, but not in 1 year and 5 years after starting dialysis. Analyses in a subset of patients with a repeated PTH in 1 year (N = 1954) showed that although persistent PTH low levels (< 150 pg/mL) at 1 year were significantly associated with all-cause mortality, this result was not sustained after multiple adjustments.
PTH < 150 pg/mL confers a high mortality risk in the first 90 days of dialysis. If this result reflects poor nutritional conditions, it deserves further investigations.
甲状旁腺激素（PTH）作为慢性肾脏病患者死亡的一个危险因素，在接受血液透析的患者中呈U形分布。然而，大多数研究并未关注初发患者以及治疗开始后90天内死亡的患者。我们评估了PTH作为巴西一大群人死亡的危险因素。
这是一项观察性队列研究，纳入了2012年7月1日至2017年6月30日期间开始血液透析的4317名成年患者。主要结局是全因死亡率。采用Fine - gray子分布风险模型评估存在竞争事件（肾移植）时的生存情况。
PTH水平中位数为252（118，479）pg/mL。治疗开始后的前90天内有331例死亡（6.7%），1年随访期间有430例（10.7%），5年研究期间有1282例（32%）。PTH＜150、150 - 600和＞600 pg/mL的死亡患者分别占38.1%、33.0%和28.5%（p＜0.001）。在调整模型中，透析开始时PTH＜150 pg/mL的患者在前90天内死亡风险较高，但在透析开始1年和5年后并非如此。对1年内重复检测PTH的部分患者（N = 1954）进行分析显示，尽管1年时持续的低PTH水平（＜150 pg/mL）与全因死亡率显著相关，但多次调整后该结果不再成立。
透析开始后的前90天内，PTH＜150 pg/mL会带来较高的死亡风险。如果这一结果反映了营养状况较差，那么值得进一步研究。
