Contribution of dysregulated serum magnesium to mortality in hemodialysis patients with secondary hyperparathyroidism: a 3-year cohort study.
Contribution of dysregulated serum magnesium to mortality in hemodialysis patients with secondary hyperparathyroidism: a 3-year cohort study.
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DOI：
10.1093/ckj/sfv097
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发表时间：
2015-12
影响因子：
4.6
通讯作者：
Fukuhara S
中科院分区：
文献类型：
--
作者：
Kurita N;Akizawa T;Fukagawa M;Onishi Y;Kurokawa K;Fukuhara S
在血液透析患者中，镁平衡紊乱对死亡率的影响程度尚不清楚。这是一项队列研究，涉及2008年至2010年在日本86家医院接受维持性血液透析的3276名继发性甲状旁腺功能亢进（SHPT）患者。基线血清镁（sMg）值分为≤2.3、>2.3 ~ 2.5、>2.5 ~ 2.7、>2.7 ~ 3.0、>3.0 mg/dL五分位数，中间五分位数作为参考。结果是全因死亡。通过Cox回归来评估对全因死亡的独立贡献，以产生人群归因分数（paf）。共分析了来自68家机构的2165名患者。与其他五分位数相比，sMg最低的五分位数与较低的血清钾和白蛋白水平、较高的c反应蛋白（CRP）水平以及房颤和脑血管疾病的患病率呈正相关。与其他五分位数相比，sMg最高的五分位数与较高的钾水平呈正相关，与较低的血清白蛋白水平、较高的完整甲状旁腺激素和CRP水平以及脑血管疾病的患病率呈负相关。在中位随访3年期间，sMg最低和第二低的五分位数与全因死亡相关[校正风险比（HR） 1.737, 95%可信区间（95% CI） 1.200-2.512, HR 1.675, 95% CI 1.254-2.238]。对于全因死亡，最高和第二高的sMg五分位数的调整hr点估计值高于中间五分位数。低sMg和高、低sMg全因死亡的校正paf分别为24.0% （95% CI 13.0-35.0%）和30.7% （95% CI 14.5-46.8%）。在伴有SHPT的血液透析患者中，sMg失调是全因死亡的重要因素。需要进一步的研究来检验sMg矫正是否能提高生存率。
The extent of contribution of disturbed magnesium balance to mortality remains unclear among hemodialysis patients. This was a cohort study involving 3276 patients on maintenance hemodialysis at 86 facilities in Japan from 2008 to 2010 who had secondary hyperparathyroidism (SHPT). Baseline serum magnesium (sMg) values were categorized into quintiles (≤2.3, >2.3–2.5, >2.5–2.7, >2.7–3.0 and >3.0 mg/dL), and the middle quintile was set as the reference. Outcome was all-cause death. Independent contribution to all-cause death was assessed via Cox regression to generate population-attributable fractions (PAFs). A total of 2165 patients from 68 facilities were analyzed. The lowest quintile of sMg was positively associated with lower serum potassium and albumin levels, higher C-reactive protein (CRP) levels and prevalence of atrial fibrillation and cerebrovascular disease than the other quintiles. The highest sMg quintile was positively associated with higher potassium levels, and negatively associated with lower serum albumin levels and higher intact parathyroid hormone and CRP levels and prevalence of cerebrovascular disease than the other quintiles. During a median follow-up of 3 years, the lowest and the second lowest quintiles of sMg were associated with all-cause death [adjusted hazard ratio (HR) 1.737, 95% confidence interval (95% CI) 1.200–2.512 and HR 1.675, 95% CI 1.254–2.238, respectively). Point estimates of adjusted HRs of the highest and the second highest sMg quintiles were higher than those of the middle quintile for all-cause death. Adjusted PAFs of lower sMg and of higher and lower sMg for all-cause death were 24.0% (95% CI 13.0–35.0%) and 30.7% (95% CI 14.5–46.8%), respectively. In hemodialysis patients with SHPT, dysregulated sMg is an important contributor to all-cause death. Further studies are warranted to examine whether or not correction of sMg improves survival.