Sircuța Alexandru Florin, Grosu Iulia Dana, Schiller Adalbert, Petrica Ligia, Ivan Viviana, Schiller Oana, Maralescu Felix-Mihai, Palamar Marcel, Mircea Monica-Nicoleta, Nișulescu Daniel, Goleț Ionuț, Bob Flaviu
Department of Internal Medicine II-Nephrology University Clinic, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania.
Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania.
Biomedicines. 2025 May 10;13(5):1163. doi: 10.3390/biomedicines13051163.
Chronic kidney disease-mineral and bone disorder (CKD-MBD) and systemic inflammation contribute to mortality in hemodialysis (HD) patients. The primary aim of this study was to determine whether specific CKD-MBD markers and inflammatory biomarkers are associated with increased mortality risk in HD patients. We conducted a retrospective cohort study on 63 stage 5D CKD patients undergoing maintenance HD. Serum intact parathyroid hormone (iPTH), soluble Klotho, calcium, phosphorus, 25(OH)D (25-hydroxyvitamin D), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), and interleukin-6 (IL-6) were analyzed. A Cox regression analysis assessed mortality predictors, and linear regression analysis evaluated CKD-MBD-inflammation correlations. Lower iPTH (<329.3 pg/mL) levels were the only significant mortality predictor ( = 0.042). Other CKD-MBD markers (calcium, phosphorus, 25(OH)D, VEGF, TGF-β) did not impact survival. Soluble Klotho correlated positively with IL-6 (r = 0.57, < 0.001), suggesting a compensatory inflammatory response. Our findings demonstrate that low iPTH levels and advanced age are independent predictors of mortality in hemodialysis patients. The positive association between soluble Klotho and IL-6 suggests a potential compensatory inflammatory response. These results highlight the need for further research to clarify underlying mechanisms and to explore novel therapeutic strategies.
慢性肾脏病-矿物质和骨异常（CKD-MBD）与全身炎症会导致血液透析（HD）患者死亡。本研究的主要目的是确定特定的CKD-MBD标志物和炎症生物标志物是否与HD患者死亡风险增加相关。我们对63例接受维持性血液透析的5D期CKD患者进行了一项回顾性队列研究。分析了血清完整甲状旁腺激素（iPTH）、可溶性klotho、钙、磷、25（OH）D（25-羟基维生素D）、转化生长因子-β（TGF-β）、血管内皮生长因子（VEGF）、C反应蛋白（CRP）和白细胞介素-6（IL-6）。Cox回归分析评估死亡预测因素，线性回归分析评估CKD-MBD与炎症的相关性。较低的iPTH（<329.3 pg/mL）水平是唯一显著的死亡预测因素（P = 0.042）。其他CKD-MBD标志物（钙、磷、25（OH）D、VEGF、TGF-β）对生存没有影响。可溶性klotho与IL-6呈正相关（r = 0.57，P < 0.001），提示存在代偿性炎症反应。我们的研究结果表明，低iPTH水平和高龄是血液透析患者死亡的独立预测因素。可溶性klotho与IL-6之间的正相关提示存在潜在的代偿性炎症反应。这些结果凸显了进一步研究以阐明潜在机制并探索新治疗策略的必要性。
