Serum phosphate levels modify the impact of parathyroid hormone levels on renal outcomes in kidney transplant recipients
Serum phosphate levels modify the impact of parathyroid hormone levels on renal outcomes in kidney transplant recipients
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DOI：
10.1038/s41598-020-70709-4
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发表时间：
2020-08-13
影响因子：
4.6
通讯作者：
Isaka, Yoshitaka
中科院分区：
文献类型：
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作者：
Doi, Yohei;Hamano, Takayuki;Isaka, Yoshitaka
单独评估矿物质骨疾病（MBD）参数，包括钙、磷酸盐、甲状旁腺激素（PTH）、成纤维细胞生长因子23（FGF 23）、25-羟基维生素D和1，25-二羟基维生素D（1，25 D），可预测肾移植受者（KTR）的肾脏结局，结果相互矛盾。到目前为止，同时评价这些参数和肾脏结局相互交织关系的数据很少。我们进行了一项前瞻性长期随访队列研究，包括263例移植后至少1年移植物功能正常的KTR。结果是估计GFR减半和移植物丢失的复合结果。采用考克斯回归分析评估一组6个MBD参数与肾脏结局之间的相关性。在中位随访10.7年期间，98例KTR发生了结局。在多变量考克斯分析中，全段PTH（iPTH）、磷酸盐和1，25 D水平与结局相关（风险比，1.60/对数标度; 95%置信区间，1.19-2.14，1.60/mg/dL; 1.14-2.23和0.82/10 pg/mL;分别为0.68-0.99）。将死亡作为竞争事件的竞争风险分析得出了类似的结果。根据iPTH和磷酸盐中位数分为四组后，在低磷酸盐水平的KTR中未观察到与高iPTH相关的高风险（P-相互作用
Separate assessment of mineral bone disorder (MBD) parameters including calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D (1,25D) predict renal outcomes in kidney transplant recipients (KTRs), with conflicting results. To date, data simultaneously evaluating these parameters and interwoven relations on renal outcomes are scarce. We conducted a prospective long-term follow-up cohort study included 263 KTRs with grafts functioning at least 1 year after transplantation. The outcome was a composite of estimated GFR halving and graft loss. Cox regression analyses were employed to evaluate associations between a panel of six MBD parameters and renal outcomes. The outcome occurred in 98 KTRs during a median follow-up of 10.7 years. In a multivariate Cox analysis, intact PTH (iPTH), phosphate, and 1,25D levels were associated with the outcome (hazard ratio, 1.60 per log scale; 95% confidence interval, 1.19-2.14, 1.60 per mg/dL; 1.14-2.23 and 0.82 per 10 pg/mL; 0.68-0.99, respectively). Competing risk analysis with death as a competing event yielded a similar result. After stratification into four groups by iPTH and phosphate medians, high risks associated with high iPTH was not observed in KTRs with low phosphate levels (P-interaction