Outcomes Associated with Serum Calcium Level in Men with Non-Dialysis-Dependent Chronic Kidney Disease
Outcomes Associated with Serum Calcium Level in Men with Non-Dialysis-Dependent Chronic Kidney Disease
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DOI：
10.2215/cjn.06040809
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发表时间：
2010-03-01
影响因子：
9.8
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
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作者：
Kovesdy, Csaba P.;Kuchmak, Olga;Kalantar-Zadeh, Kamyar
背景和目的：血清钙升高与透析患者死亡率增加有关，但尚不清楚非透析依赖性（NDD）慢性肾病（CKD）是否也存在同样的情况。与低血清钙相关的结果也没有得到很好的表征。 设计、设置、参与者和测量：我们使用 Cox 模型，在 1243 名中度和晚期 NDD CKD 男性的历史前瞻性队列中检查了基线、时变和时间平均血清钙与全因死亡率的关联。结果：血清钙与死亡率的关联因应用而异。 统计模型。较高的基线钙和时间平均钙与较高的死亡率相关（多变量调整风险比（95% 置信区间）：1.31 (1.13, 1.53)；基线钙高 1 mg/dl 时，P < 0.001）。然而，在随时间变化的分析中，较低的钙水平与死亡率增加相关。 结论：对于 NDD CKD 患者，较高的血清钙与长期死亡率增加相关（如基线和时间平均模型所反映），而较低的血清钙与短期死亡率增加相关（如时变模型所反映）。有必要进行临床试验来确定维持正常的血清钙是否可以改善这些患者的预后。
Background and objectives: Elevated serum calcium has been associated with increased mortality in dialysis patients, but it is unclear whether the same is true in non-dialysis-dependent (NDD) chronic kidney disease (CKD). Outcomes associated with low serum calcium are also not well-characterized.Design, setting, participants, & measurements: We examined associations of baseline, time-varying, and time-averaged serum calcium with all-cause mortality in a historic prospective cohort of 1243 men with moderate and advanced NDD CKD by using Cox models.Results: The association of serum calcium with mortality varied according to the applied statistical models. Higher baseline calcium and time-averaged calcium were associated with higher mortality (multivariable adjusted hazard ratio (95% confidence interval): 1.31 (1.13, 1.53); P < 0.001 for a baseline calcium 1 mg/dl higher). However, in time-varying analyses, lower calcium levels were associated with increased mortality.Conclusions: Higher serum calcium is associated with increased long-term mortality (as reflected by the baseline and time-averaged models), and lower serum calcium is associated with increased short-term mortality (as reflected by the time-varying models) in patients with NDD CKD. Clinical trials are war-ranted to determine whether maintaining normal serum calcium can improve outcomes in these patients.