Achievement of NKF/K-DOQI Recommended Target Values for Bone and Mineral Metabolism in Incident Hemodialysis Patients: Results of the FARO-2 Cohort
Achievement of NKF/K-DOQI Recommended Target Values for Bone and Mineral Metabolism in Incident Hemodialysis Patients: Results of the FARO-2 Cohort
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DOI：
10.1159/000365386
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发表时间：
2014-01-01
影响因子：
3
通讯作者：
Mazzaferro, Sandro
中科院分区：
文献类型：
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作者：
Cozzolino, Mario;Messa, Piergiorgio;Mazzaferro, Sandro
背景：矿物质骨病（MBD）在血液透析（HD）患者中普遍存在，并与心血管死亡率增加相关。FARO-2研究评估了NKF/K-DOQI指南中关于血清钙（Ca）、磷（P）和全段甲状旁腺激素（PTH）水平的推荐目标值对HD患者生存率的影响。研究方法：通过问卷调查收集了来自26家意大利透析单位的568例HD患者的数据，这些患者在3年内进行了前瞻性随访。通过Kaplan-Meier曲线确定CKD-MBD治疗特征的至死亡时间的累积概率。结果如下：血清PTH水平（6个月与36个月时的中位数; 225与254 pg/ml）、Ca（8.8与8.9 g/dl）和P（5.1与4.8 mg/dl）在6个月与随访时无显著差异。随访36个月的大多数HD患者（60-70%）未达到NKF/K-DOQI推荐的目标值。三个参数达标患者的生存率高于脱靶患者（24个月生存率：达标95.7%（95% CI：84.0-98.9）vs未达标71.1%（95% CI：66.3-75.4，p < 0.01））。在随访期间，30.1%的患者在三个MBD参数方面至少达到一次目标，与未达到这些目标的患者相比，其生存率更高（24个月生存率：至少一次88.0%（95% CI：81.9-92.1）; 67.7%（95% CI：61.9-72.8，p < 0.01））。结论：我们的研究结果表明，至少一次访视达到目标水平（三个MBD参数）的HD患者的死亡风险较低。(C)2014 S. Karger AG，巴塞尔
Background: Mineral Bone Disorders (MBD) is prevalent in hemodialysis (HD) patients and associated with increased cardiovascular mortality. The FARO-2 study evaluated the achievement of the NKF/K-DOQI guidelines on recommended target values for serum calcium (Ca), phosphorous (P) and intact parathyroid hormone (PTH) levels on survival in incident HD patients. Methods: Data were collected by questionnaire from 568 incident HD patients followed prospectively over a 3-year period from 26 Italian dialysis units. The cumulative probability of time-to-death for CKD-MBD treatment characteristics was determined by the Kaplan-Meier curves. Results: Serum PTH levels (median values at 6 months vs. 36 months; 225 vs. 254 pg/ml), Ca (8.8 vs. 8.9 g/dl) and P (5.1 vs. 4.8 mg/dl) were not significantly different at 6 months versus follow-up. The majority of incident HD patients (60-70%) who were followed up for 36 months did not achieve the NKF/K-DOQI recommended target values. Survival rates were higher in patients on target for three parameters versus patients off target (survival at 24 months: at target 95.7% (95% CI: 84.0-98.9) versus not on target 71.1% (95% CI: 66.3-75.4, p < 0.01)). The 30.1% of patients on target for three MBD parameters at least once during the follow-up period had better survival rates compared to those not reaching these targets (survival at 24 months: at least once 88.0% (95% CI: 81.9-92.1); 67.7% (95% CI: 61.9-72.8, p < 0.01)). Conclusion: Our findings indicate that incident HD patients who achieved target levels (for three MBD parameters) for at least one visit have a lower risk of mortality. (C) 2014 S. Karger AG, Basel