Correlates of parathyroid hormone concentration in hemodialysis patients
Correlates of parathyroid hormone concentration in hemodialysis patients
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DOI：
10.1093/ndt/gfs598
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发表时间：
2013-06-01
影响因子：
6.1
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
--
作者：
Li, Jinnan;Molnar, Miklos Z.;Kalantar-Zadeh, Kamyar
化学性甲状旁腺功能亢进对维持性血液透析（MHD）中骨和矿物质代谢指标的影响尚不清楚。我们假设较高的血清完整甲状旁腺激素（iPTH）水平与较高的高磷血症、高磷酸酶血症（高血清碱性磷酸酶（ALP）水平）和高钙血症的可能性相关。在8年的时间里（2001年7月至2009年6月），我们从一家大型透析诊所确定了106 760名患有iPTH和钙（Ca）、磷(P)和ALP数据的MHD患者。检验Logistic回归模型以评估血清iPTH增量与高磷血症（p5.5 mg/dL）、高钙血症（ca10.2 mg/dL）和高磷酸血症（alp120 U/L）可能性之间的关系。患者61例，年龄16岁，女性45例，糖尿病患者59例，黑人33例。与iPTH水平为100 ~ 200 pg/mL的患者相比，iPTH水平为600700、700 ~ 800和800 pg/mL的患者发生高磷血症的风险分别增加122 （OR: 2.22, 95 CI: 2.042.41）、153 （OR: 2.53, 95 CI: 2.292.80）和243 (OR: 3.43, 95 CI: 3.223.66)，高磷血症的风险分别增加109 （OR: 2.09, 95 CI: 1.932.26）、130 （OR: 2.30, 95 CI: 2.102.52）和376 （OR: 4.76, 95 CI: 4.505.04）。与100 ~ 200 pg/mL iPTH水平相比，低iPTH （100 pg/mL, OR: 2.45, 95 CI: 2.272.64）和高iPTH （800 pg/mL: OR: 2.13, 95 CI: 1.952.33）水平均与高钙血症相关。高水平的甲状旁腺激素与高磷血症和高磷血症相关，而极低和高水平的甲状旁腺激素与高钙血症相关。如果这些关联是因果关系，甲状旁腺功能亢进的纠正可能对MHD患者的骨和矿物质紊乱具有总体意义。
The implications of chemical hyperparathyroidism on bone and mineral metabolism measures in maintenance hemodialysis (MHD) are not well known. We hypothesized that a higher serum intact parathyroid hormone (iPTH) level is associated with the higher likelihood of hyperphosphatemia, hyperphosphatasemia [high serum alkaline phosphatase (ALP) levels] and hypercalcemia.Over an 8-year period (July 2001June 2009), we identified 106 760 MHD patients with iPTH and calcium (Ca), phosphorous (P) and ALP data from a large dialysis clinic. Logistic regression models were examined to assess the association between serum iPTH increments and the likelihood of hyperphosphatemia (P 5.5 mg/dL), hypercalcemia (Ca 10.2 mg/dL) and hyperphosphatasemia (ALP 120 U/L).Patients were 61 16 years old and included 45 women, 59 diabetics and 33 Blacks. Compared with an iPTH level of 100 to 200 pg/mL, patients with an iPTH level of 600700, 700 to 800 and 800 pg/mL had 122 (OR: 2.22, 95 CI: 2.042.41), 153 (OR: 2.53, 95 CI: 2.292.80) and 243 (OR: 3.43, 95 CI: 3.223.66) higher risk of hyperphosphatemia, respectively, and had 109 (OR: 2.09, 95 CI: 1.932.26), 130 (OR: 2.30, 95 CI: 2.102.52) and 376 (OR: 4.76, 95 CI: 4.505.04) higher risk of hyperphosphatasemia, respectively. Compared with an iPTH level of 100 to 200 pg/mL, both the low iPTH (100 pg/mL, OR: 2.45, 95 CI: 2.272.64) and the high iPTH (800 pg/mL: OR: 2.13, 95 CI: 1.952.33) levels were associated with hypercalcemia.Higher levels of iPTH are incremental correlates of hyperphosphatemia and hyperphosphatasemia, whereas both very low and high PTH levels are linked to hypercalcemia. If these associations are causal, correction of hyperparathyroidism may have overarching implications on bone and mineral disorders in MHD patients.