Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis
Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis
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DOI：
10.1186/1471-2369-14-88
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发表时间：
2013-04-17
期刊：
影响因子：
2.3
通讯作者：
Belozeroff, Vasily
中科院分区：
文献类型：
--
作者：
Natoli, Jaime L.;Boer, Rob;Belozeroff, Vasily
背景：矿物质代谢改变的生化标记物与终末期肾病患者死亡率的增加有关。一些研究已经证明了这些矿物质与死亡率之间的非线性关系(U型或J型)，尽管许多研究人员在他们的统计模型中假设了线性关系。这一分析综合了研究之间的非线性关系。方法：我们更新了之前的系统回顾，直到2010年。研究包括接受透析的成年人，并报告了钙、磷和/或甲状旁腺激素(PTH)的分类数据以及全因死亡率。我们进行了两项不同的荟萃分析，以比较高于参照水平与参照水平和低于参照水平与参照水平。结果：一项文献综述显示，当假设矿物质与死亡率之间存在线性关系时，与非线性模型相比，估计的相关性更有可能较小或不显著。在Meta分析中，磷(4项研究，RR=1.20，95%CI=1.15-1.25)、钙(3项研究，RR=1.10，95%CI=1.05-1.14)和甲状旁腺素(5项研究，RR=1.11，95%CI=1.07-1.16)与死亡率显著相关。虽然相对较低的磷或甲状旁腺素与死亡率没有明显的相关性，但观察到低于参考水平的钙的保护作用(RR=0.86，95%CI=0.83-0.89)。结论：在一系列适合于非线性关系荟萃分析的观察性研究中，透析患者的甲状旁腺素、钙和磷水平高于参考水平与死亡风险增加相关。低于参考值的研究结果不太一致。未来的分析应纳入矿物质和死亡率之间的非线性关系，以获得准确的影响估计。
Background: Biochemical markers of altered mineral metabolism have been associated with increased mortality in end stage renal disease patients. Several studies have demonstrated non-linear (U-shaped or J-shaped) associations between these minerals and mortality, though many researchers have assumed linear relationships in their statistical modeling. This analysis synthesizes the non-linear relationships across studies.Methods: We updated a prior systematic review through 2010. Studies included adults receiving dialysis and reported categorical data for calcium, phosphorus, and/or parathyroid hormone (PTH) together with all-cause mortality. We performed 2 separate meta-analyses to compare higher-than-referent levels vs referent and lower-than-referent levels vs referent levels.Results: A literature review showed that when a linear relationship between the minerals and mortality was assumed, the estimated associations were more likely to be smaller or non-significant compared to non-linear models. In the meta-analyses, higher-than-referent levels of phosphorus (4 studies, RR = 1.20, 95% CI = 1.15-1.25), calcium (3 studies, RR = 1.10, 95% CI = 1.05-1.14), and PTH (5 studies, RR = 1.11, 95% CI = 1.07-1.16) were significantly associated with increased mortality. Although no significant associations between relatively low phosphorus or PTH and mortality were observed, a protective effect was observed for lower-than-referent calcium (RR = 0.86, 95% CI = 0.83-0.89).Conclusions: Higher-than-referent levels of PTH, calcium, and phosphorus in dialysis patients were associated with increased mortality risk in a selection of observational studies suitable for meta-analysis of non-linear relationships. Findings were less consistent for lower-than-referent values. Future analyses should incorporate the non-linear relationships between the minerals and mortality to obtain accurate effect estimates.