Serum phosphate levels and mortality risk among people with chronic kidney disease
Serum phosphate levels and mortality risk among people with chronic kidney disease
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DOI：
10.1681/asn.2004070602
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发表时间：
2005-02-01
影响因子：
13.6
通讯作者：
Andress, DL
中科院分区：
文献类型：
--
作者：
Kestenbaum, B;Sampson, JN;Andress, DL
血磷水平升高与透析患者的血管钙化和死亡率有关。磷酸盐和死亡率之间的关系尚未在慢性肾脏病（CKD）患者中探索。一项回顾性队列研究是在太平洋西北部的八个退伍军人事务医疗中心进行的。CKD定义为1999年至2002年期间至少间隔6个月的两次连续异常门诊血清肌酐测量值。排除了接受长期透析的患者、目前或既往接受过肾移植的患者以及近期未进行磷酸盐测量的患者。主要终点为全因死亡率。次要终点为急性心肌梗死和心肌梗死加死亡的联合终点。共有95，619名退伍军人至少有一个初级保健或内科诊所接触西北VA设施和两个或两个以上的血清肌酐门诊测量，至少间隔6个月，1月1日之间。1999年和2002年12月31日，被确定。在这一合格人群中，7021例患者符合我们对CKD的定义。排除后，6730例CKD患者可用于分析，3490例在前18个月内进行了血清磷酸盐测量。校正后，血清磷酸盐水平>3.5 mg/dl与死亡风险显著增加相关。死亡风险随血清磷酸盐水平随后每增加0.5 mg/dl而线性增加。血清磷水平升高与CKD患者死亡风险增加独立相关。
Elevated serum phosphate levels have been linked with vascular calcification and mortality among dialysis patients. The relationship between phosphate and mortality has not been explored among patients with chronic kidney disease (CKD). A retrospective cohort study was conducted from eight Veterans Affairs' Medical Centers located in the Pacific Northwest. CKD was defined by two continuously abnormal outpatient serum creatinine measurements at least 6 mo apart between 1999 and 2002. Patients who received chronic dialysis, those with a present or previous renal transplant, and those without a recent phosphate measurement were excluded. The primary end point was all-cause mortality. Secondary end points were acute myocardial infarction and the combined end point of myocardial infarction plus death. A total of 95,619 veterans with at least one primary care or internal medicine clinic contact from a Northwest VA facility and two or more outpatient measurements of serum creatinine, at least 6 mo apart, between January 1. 1999, and December 31, 2002, were identified. From this eligible population, 7021 patients met our definition of CKD. After exclusions, 6730 CKD patients were available for analysis, and 3490 had a serum phosphate measurement during the previous 18 mo. After adjustment, serum phosphate levels >3.5 mg/dl were associated with a significantly increased risk for death. Mortality risk increased linearly with each subsequent 0.5-mg/dl increase in serum phosphate levels. Elevated serum phosphate levels were independently associated with increased mortality risk among this population of patients with CKD.