Avila Marcela, Mora Carmen, Prado-Uribe Ma Del Carmen, Cueto-Manzano Alfonso, Qureshi Abdul Rashid, Lindholm Bengt, Bernal Amador Alma Sofía, Paniagua Ramón
Unidad de Investigación Médica en Enfermedaes Nefrológicas, Hospital de Especialidades, CMN SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Col. Doctores, Mexico City 06720, Mexico.
Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, Instituto Mexicano del Seguro Social, Guadalajara 44320, Mexico.
Biomedicines. 2024 Sep 2;12(9):1990. doi: 10.3390/biomedicines12091990.
Mineral bone disease (MBD) is common in dialysis patients. Genetics and the hormonal environment influence the clinical picture and outcomes of women. This study aimed to determine how these factors affect mortality. In 234 female dialysis patients on Continuous Ambulatory (48%) or Automated (29%) Peritoneal Dialysis or Hemodialysis (23%), MBD biochemical variables, as well as bone density and genetic Bsm1 polymorphism of vitamin D receptor (VDR) were performed at baseline. The cohort was followed-up by 17 (IQ range 15-31) months. According to VDR polymorphism, the distribution of patients was bb: 64% and BB+Bb: 36%. Fifty-five patients died from all-cause mortality; the hs-C-reactive protein level was the most significant risk in multivariate Cox analysis. Nineteen died from cardiovascular mortality. None of the variables were significant for cardiovascular mortality. Patients with bb plus inflammation had the highest risk in the analysis; the significance persisted after adjustment for age, diabetes, and parathyroid hormone levels HR 2.33 (95% CI, 1.01-8.33) and after further adjustment for time on dialysis, albumin, and Osteoprotegerin levels HR 3.49 (95% CI, 1.20-10.9). The presence of the bb genotype from VDR and inflammation had the highest risk of death from all-cause mortality in females on CAPD, APD, and HD patient.
矿物质骨病（MBD）在透析患者中很常见。遗传因素和激素环境会影响女性的临床表现和预后。本研究旨在确定这些因素如何影响死亡率。对234名接受持续性非卧床腹膜透析（48%）、自动化腹膜透析（29%）或血液透析（23%）的女性透析患者，在基线时检测了MBD生化指标、骨密度以及维生素D受体（VDR）的基因Bsm1多态性。该队列随访了17（四分位间距15 - 31）个月。根据VDR多态性，患者分布为bb：64%，BB + Bb：36%。55名患者死于全因死亡率；高敏C反应蛋白水平是多变量Cox分析中最显著的风险因素。19名患者死于心血管疾病死亡率。没有变量对心血管疾病死亡率有显著影响。在分析中，bb型加上炎症的患者风险最高；在调整年龄、糖尿病和甲状旁腺激素水平后，该显著性仍然存在，风险比（HR）为2.33（95%置信区间，1.01 - 8.33），在进一步调整透析时间、白蛋白和骨保护素水平后，HR为3.49（95%置信区间，1.20 - 10.9）。在持续性非卧床腹膜透析、自动化腹膜透析和血液透析的女性患者中，VDR的bb基因型与炎症共同存在时，全因死亡率导致的死亡风险最高。
