Effect Modifying Role of Serum Calcium on Mortality-Predictability of PTH and Alkaline Phosphatase in Hemodialysis Patients: An Investigation Using Data from the Taiwan Renal Registry Data System from 2005 to 2012.
Effect Modifying Role of Serum Calcium on Mortality-Predictability of PTH and Alkaline Phosphatase in Hemodialysis Patients: An Investigation Using Data from the Taiwan Renal Registry Data System from 2005 to 2012.
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DOI：
10.1371/journal.pone.0129737
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Taiwan Society of Nephrology
中科院分区：
文献类型：
--
作者：
Lin YC;Lin YC;Hsu CY;Kao CC;Chang FC;Chen TW;Chen HH;Hsu CC;Wu MS;Taiwan Society of Nephrology
基于低全段甲状旁腺激素水平预测透析患者的死亡率是困难的，因为铝中毒、营养不良、老年、种族、糖尿病或腹膜透析可能影响这些水平。我们使用敏感的、分层的和调整的模型和全国范围的透析数据库，研究了低甲状旁腺激素水平与透析患者死亡率相关的临床意义。我们分析了2005年至2012年台湾肾脏登记数据系统中的数据，本研究纳入了94，983例具有完整甲状旁腺水平有效数据的血液透析患者。根据全段甲状旁腺激素和碱性磷酸酶水平对患者队列进行细分。该队列的平均血液透析持续时间为3.5年。平均（标准差）年龄为62（14）岁。校正年龄、性别、糖尿病、血液透析持续时间、血清白蛋白水平、红细胞压积水平、钙水平、磷酸盐水平和血液透析治疗充分性评分后，当碱性磷酸酶水平较高或全段甲状旁腺激素水平较低时，单池Kt/V、粗死亡率和校正全因死亡率均升高。一般来说，在任何给定的血清钙或磷酸盐水平下，全段甲状旁腺激素水平低的患者的死亡率高于iPTH水平正常或高的患者。在给定的碱性磷酸酶水平下，全因死亡率的风险比为1.33（p < 0.01，95%置信区间1.27-1.39）在全段甲状旁腺激素水平< 150 pg/mL和血清钙水平> 9.5 mg/dL的组中，但在全段甲状旁腺激素水平> 300 pg/mL和血清钙水平> 9.5 mg/dL的组中，风险比为0.92（95%置信区间0.85-1.01）。因此，维持白蛋白校正的高血清钙水平> 9.5 mg/dL可能与低全段甲状旁腺激素水平患者的不良预后相关。
Predicting mortality in dialysis patients based on low intact parathyroid hormone levels is difficult, because aluminum intoxication, malnutrition, older age, race, diabetes, or peritoneal dialysis may influence these levels. We investigated the clinical implications of low parathyroid hormone levels in relation to the mortality of dialysis patients using sensitive, stratified, and adjusted models and a nationwide dialysis database. We analyzed data from 2005 to 2012 that were held on the Taiwan Renal Registry Data System, and 94,983 hemodialysis patients with valid data regarding their intact parathyroid levels were included in this study. The patient cohort was subdivided based on the intact parathyroid hormone and alkaline phosphatase levels. The mean hemodialysis duration within this cohort was 3.5 years. The mean (standard deviation) age was 62 (14) years. After adjusting for age, sex, diabetes, the hemodialysis duration, serum albumin levels, hematocrit levels, calcium levels, phosphate levels, and the hemodialysis treatment adequacy score, the single-pool Kt/V, the crude and adjusted all-cause mortality rates increased when alkaline phosphatase levels were higher or intact parathyroid hormone levels were lower. In general, at any given level of serum calcium or phosphate, patients with low intact parathyroid hormone levels had higher mortality rates than those with normal or high iPTH levels. At a given alkaline phosphatase level, the hazard ratio for all-cause mortality was 1.33 (p < 0.01, 95% confidence interval 1.27–1.39) in the group with intact parathyroid hormone levels < 150 pg/mL and serum calcium levels > 9.5 mg/dL, but in the group with intact parathyroid hormone levels > 300 pg/mL and serum calcium levels > 9.5 mg/dL, the hazard ratio was 0.92 (95% confidence interval 0.85–1.01). Hence, maintaining albumin-corrected high serum calcium levels at > 9.5 mg/dL may correlate with poor prognoses for patients with low intact parathyroid hormone levels.
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影响因子：
9.3
作者：
Inaba, M;Nakatsuka, K;Nishizawa, Y
通讯作者：
Nishizawa, Y
影响因子：
2.3
作者：
Natoli, Jaime L.;Boer, Rob;Belozeroff, Vasily
通讯作者：
Belozeroff, Vasily
影响因子：
6.1
作者：
Li, Jinnan;Molnar, Miklos Z.;Kalantar-Zadeh, Kamyar
通讯作者：
Kalantar-Zadeh, Kamyar
影响因子：
6.1
作者：
Hwang, Shang-Jyh;Lin, Ming-Yen;Mau, Lih-Wen
通讯作者：
Mau, Lih-Wen
DOI：
10.1053/j.jrn.2009.10.006
发表时间：
2010-07
期刊：
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
影响因子：
--
作者：
Dukkipati R;Kovesdy CP;Colman S;Budoff MJ;Nissenson AR;Sprague SM;Kopple JD;Kalantar-Zadeh K
通讯作者：
Kalantar-Zadeh K