PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis
PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis
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DOI：
10.1053/j.ajkd.2005.09.024
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发表时间：
2006-01-01
影响因子：
13.2
通讯作者：
Chertow, GM
中科院分区：
文献类型：
--
作者：
Danese, MD;Kim, J;Chertow, GM
研究背景：在终末期肾脏疾病人群中，骨折风险及其与钙（Ca）、磷(P)和甲状旁腺激素（PTH）代谢紊乱的关系很少。方法：从透析发病率和死亡率研究（DMMS）第1至4波中获得钙、磷和甲状旁腺激素的实验室值。来自美国肾脏数据系统的其他数据被用于确定9,007例患者髋部、椎体和骨盆骨折的发生率和相关费用，这些患者的实验室值未丢失，医疗保险作为主要付款人。采用Cox比例风险模型和泊松模型分别分析首次骨折时间和骨折数量。结果：Ca、P值与骨折风险无相关性；泊松回归分析显示，椎体和髋部骨折风险与甲状旁腺激素浓度呈U型关系，且差异不显著（P = 0.03）。骨折后经年龄和性别调整的死亡率（580/ 1000人年）是DMMS中普通透析患者（217/ 1000人年）的2.7倍。髋部、椎体和骨盆骨折的平均总发作费用分别为20,810 +/- 16,743美元（SD）、17,063 +/- 26,201美元和14,475 +/- 19,209美元。结论：使用DMMS的数据，Ca和P浓度与骨折风险之间没有关联。髋部和椎体骨折的风险与甲状旁腺激素浓度的相关性较弱，在甲状旁腺激素浓度为300 pg/mL （ng/L）时，风险最低。骨折与高死亡率和高成本相关。需要前瞻性研究来确定维持PTH浓度在国家肾脏基金会-肾脏疾病结局质量倡议范围内或附近的治疗是否会减少矿物质代谢紊乱的并发症。
Background Few investigations have described fracture risk and its relation to disorders in calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) metabolism in the end-stage renal disease population.Methods: Laboratory values for Ca, P, and PTH were obtained from Dialysis Morbidity and Mortality Study (DMMS) Waves 1 to 4. Additional data available from the US Renal Data System were used to determine the incidence and associated costs of hip, vertebral, and pelvic fractures in 9,007 patients with nonmissing laboratory values and Medicare as primary payor. Cox proportional hazards and Poisson models were used to analyze time to first fracture and numbers of fractures, respectively.Results: There was no association between Ca or P values and risk for fracture; risks for vertebral and hip fractures and PTH concentrations were U shaped and weakly significant using Poisson regression (P = 0.03). The age- and sex-adjusted mortality rate after fracture was 2.7 times greater (580/1,000 person-years) than for general dialysis patients from the DMMS (217/1,000 person-years). Mean total episodic costs of hip, vertebral, and pelvic fractures were $20,810 +/- $16,743 (SD), $17,063 +/- $26,201, and $14,475 +/- $19,209, respectively.Conclusion: Using data from the DMMS, there were no associations between Ca and P concentrations and risk for fracture. Risks for hip and vertebral fracture were associated weakly with PTH concentration, with the lowest risk observed around a PTH concentration of 300 pg/mL (ng/L). Fractures were associated with high subsequent mortality and costs. Prospective studies are needed to determine whether therapies that maintain PTH concentrations within or near the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative range will result in fewer complications of disordered mineral metabolism.