Anumas Suthiya, Tantiyavarong Pichaya, Pattharanitima Pattharawin
Chulabhorn International College of Medicine, Thammasat University, Rangsit 12120, Pathum Thani, Thailand.
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Rangsit 12120, Pathum Thani, Thailand.
J Clin Med. 2025 May 9;14(10):3311. doi: 10.3390/jcm14103311.
: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a key contributor to complications, including ischemic heart disease (IHD), which significantly elevates mortality in patients with chronic kidney disease (CKD). This study aims to identify factors associated with IHD risk in pre-dialysis CKD and establish the minimum parathyroid hormone (PTH) threshold necessary to mitigate this risk. : We retrospectively analyzed data from CKD stage 3-5ND patients aged over 18 years, followed from 2018 to 2022. IHD was identified using ICD-10 codes. An adjusted Cox regression model and joint modeling analysis were used to assess the association between risk factors and IHD. A total of 1210 CKD patients were included in the analysis, with a median follow-up duration of 513.5 days (IQR 189-979). The incidence of IHD was 7.5%. PTH levels ≥166 ng/L (HR 1.87, 95% CI 1.05-3.35, = 0.03) and age ≥65 years (HR 1.68, 95% CI 1.003-2.81, = 0.04) were significantly associated with an increased risk of IHD. In joint modeling analysis, time-varying PTH, age ≥65 years, and diabetes mellitus (DM) were significantly associated with an increased risk of IHD, whereas ARB and statin use were associated with a reduced risk. Calcium and phosphate levels did not demonstrate significant associations with IHD risk. Baseline PTH levels ≥166 ng/L and time-varying PTH were independently and significantly associated with an increased risk of IHD. In contrast, calcium and phosphate levels showed no significant association with IHD risk.
慢性肾脏病 - 矿物质和骨代谢紊乱（CKD - MBD）是并发症的关键促成因素，包括缺血性心脏病（IHD），这显著提高了慢性肾脏病（CKD）患者的死亡率。本研究旨在确定透析前CKD患者中与IHD风险相关的因素，并确定降低该风险所需的最低甲状旁腺激素（PTH）阈值。：我们回顾性分析了2018年至2022年期间年龄超过18岁的3 - 5ND期CKD患者的数据。使用ICD - 10编码确定IHD。采用调整后的Cox回归模型和联合建模分析来评估风险因素与IHD之间的关联。共有1210例CKD患者纳入分析，中位随访时间为513.5天（四分位间距189 - 979）。IHD的发生率为7.5%。PTH水平≥166 ng/L（风险比1.87，95%置信区间1.05 - 3.35，P = 0.03）和年龄≥65岁（风险比1.68，95%置信区间1.003 - 2.81，P = 0.04）与IHD风险增加显著相关。在联合建模分析中，随时间变化的PTH、年龄≥65岁和糖尿病（DM）与IHD风险增加显著相关，而使用ARB和他汀类药物与风险降低相关。钙和磷水平与IHD风险无显著关联。基线PTH水平≥166 ng/L和随时间变化的PTH与IHD风险增加独立且显著相关。相比之下，钙和磷水平与IHD风险无显著关联。
