Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis
Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis
复制标题
血清磷控制持续时间与腹膜透析患者总体死亡率相关
DOI：
10.1159/000507785
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发表时间：
2020-11-01
期刊：
影响因子：
3.7
通讯作者：
Ai, Jun
中科院分区：
文献类型：
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作者：
Gong, Nirong;Xiao, Zhiwen;Ai, Jun
背景：血清磷(SP)水平与总死亡率和心血管事件密切相关，而SP控制持续时间的作用尚未得到充分认识。在这里，我们在我们的科室进行了一项回顾性队列研究，以确定腹膜透析(PD)患者的SP控制持续时间与临床结果的关系。方法：对2009年1月1日至2019年6月30日在本中心就诊的帕金森病患者，每隔2个月(第一年)或5个月(第二次随访期)进行随访，直至死亡，直至帕金森病停药，或至2019年6月30日。每个随访点的数据都从他们的医疗记录中收集。分析总死亡率、PD停用(包括死亡、转入血液透析和接受肾移植)和综合终点(包括死亡、急性心力衰竭、心血管事件和中风)、SP水平、SP较基线的变化程度和SP控制持续时间。结果：共530例患者进入分析。其中456例(86.0%)透析前有高磷血症，透析后即刻SP水平下降。透析后3个月SP较基线变化程度最大(−为31.0%)，且程度越低总死亡率越高(危险比[HR]，1.012；95%CI，1.004~1.020；p=0.003)。SP控制期的中位数为13(5-28)个月，持续时间越长，总死亡率越低(HR，0.968；95%CI，0.956-0.981；P<；0.001)。分类后，病程超过12个月组的总死亡率显著提高，其HR分别为0.197(0.082-0.458；P<；0.001 vs SP从未控制组)和0.329(0.150-0.724；p=0.006 vs.持续12个月组)。较长的SP控制持续时间也可改善帕金森病戒断和合并终点。结论：总而言之，SP控制的程度和持续时间与总死亡率密切相关。我们应该尽早、尽可能长地控制SP水平。
Background: Serum phosphorus (SP) level is closely associated with overall mortality and cardiovascular events, while the role of SP controlled duration is not fully recognized. Here, we conducted a retrospective cohort study in our department to identify the relationship of SP controlled duration with clinical outcomes in patients undergoing peritoneal dialysis (PD). Methods: PD patients in our center from January 1, 2009, to June 30, 2019, were followed up at 2-month (the first year) or 5-month (the next follow-up period) intervals, and until death, until PD withdrawal, or until June 30, 2019. Data at each follow-up point were collected from their medical records. SP levels, changed degree of SP over baseline, and SP controlled duration were analyzed with overall mortality, PD withdrawal (including death, transferred to hemodialysis, and received renal transplantation), and combined endpoint (including death, acute heart failure, cardiovascular event, and stroke). Results: A total of 530 patients entered the analysis. Of them, 456 (86.0%) had hyperphosphatemia before dialysis, and the SP levels decreased soon after dialysis. The degree of SP change over baseline was the maximum at the 3rd month after dialysis (−31.0%), and lower degree was associated with higher overall mortality (hazard ratio [HR], 1.012; 95% CI, 1.004–1.020; p = 0.003). The median SP controlled duration was 13 (5–28) months, and longer duration was significantly associated with lower overall mortality (HR, 0.968; 95% CI, 0.956–0.981; p < 0.001). After categorization, duration more than 12 months greatly improved overall mortality with a HR of 0.197 (0.082–0.458; p < 0.001 vs. SP never controlled group) and 0.329 (0.150–0.724; p = 0.006 vs. duration <12 months group). Longer SP controlled duration also improved PD withdrawal and combined endpoint. Conclusions: In summary, both degree and duration of SP control were tightly associated with overall mortality. We should control SP levels as early, as possible, and as long as we could.