Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort.
Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort.
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DOI：
10.1053/j.ajkd.2017.04.014
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发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Bostom A
中科院分区：
文献类型：
--
作者：
Merhi B;Shireman T;Carpenter MA;Kusek JW;Jacques P;Pfeffer M;Rao M;Foster MC;Kim SJ;Pesavento TE;Smith SR;Kew CE;House AA;Gohh R;Weiner DE;Levey AS;Ix JH;Bostom A
轻度高磷血症是心血管疾病[CVD]、肾功能丧失和死亡的假定危险因素。从大型多中心肾移植受者（KTR）队列中获得的数据非常有限，这些队列评估了血清磷水平与CVD结局、移植失败或全因死亡率之间的潜在关系。队列研究。叶酸减少移植血管结局（FAVORIT）试验，一项大型、多中心、多种族、对照临床试验，提供了明确的证据，证明基于高剂量维生素B降低血浆同型半胱氨酸水平不会减少稳定KTR的CVD事件、移植失败或总死亡率。在随机化时测定了3，138名FAVORIT试验参与者的血清磷水平。在中位随访4.0年期间，该队列有436例CVD事件，238例移植失败和348例死亡。比例风险模型显示，血清磷水平每升高1 mg/dL与CVD风险的显著增加无关（HR，1.06; 95% CI，0.92-1.22），但移植失败增加（HR，1.36; 95% CI，1.15-1.62）和总死亡风险相关性（HR，1.21; 95% CI，1.04-1.40），调整治疗分配、传统CVD风险因素、肾脏指标、肾移植类型、移植年份，以及使用钙调磷酸酶抑制剂、类固醇或降脂药物。这些相关性在没有肾脏测量的模型中得到加强：CVD（HR，1.14; 95% CI，1.00-1.31），移植失败（HR，1.72; 95% CI，1.46-2.01）和死亡率（HR，1.34; 95% CI，1.15-1.54）。我们缺乏甲状旁腺激素、成纤维细胞生长因子23或维生素D代谢物浓度的数据。血清磷水平与CVD轻微相关，与长期KTR的移植失败和总死亡率密切相关。可能需要在KTR中进行一项随机对照临床试验，评估降磷治疗对这些硬结果的潜在影响。
Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potential relationships between serum phosphorus levels and the development of CVD outcomes, transplant failure, or all-cause mortality. Cohort study. The Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial, a large, multicenter, multiethnic, controlled clinical trial that provided definitive evidence that high-dose vitamin B–based lowering of plasma homocysteine levels did not reduce CVD events, transplant failure, or total mortality in stable KTRs. Serum phosphorus levels were determined in 3,138 FAVORIT trial participants at randomization. During a median follow-up of 4.0 years, the cohort had 436 CVD events, 238 transplant failures, and 348 deaths. Proportional hazards modeling revealed that each 1-mg/dL higher serum phosphorus level was not associated with a significant increase in CVD risk (HR, 1.06; 95% CI, 0.92–1.22), but increased transplant failure (HR, 1.36; 95% CI, 1.15–1.62) and total mortality risk associations (HR, 1.21; 95% CI, 1.04–1.40) when adjusted for treatment allocation, traditional CVD risk factors, kidney measures, type of kidney transplant, transplant vintage, and use of calcineurin inhibitors, steroids, or lipid-lowering drugs. These associations were strengthened in models without kidney measures: CVD (HR, 1.14; 95% CI, 1.00–1.31), transplant failure (HR, 1.72; 95% CI, 1.46–2.01), and mortality (HR, 1.34; 95% CI, 1.15–1.54). We lacked data for concentrations of parathyroid hormone, fibroblast growth factor 23, or vitamin D metabolites. Serum phosphorus level is marginally associated with CVD and more strongly associated with transplant failure and total mortality in long-term KTRs. A randomized controlled clinical trial in KTRs that assesses the potential impact of phosphorus-lowering therapy on these hard outcomes may be warranted.
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影响因子：
7.3
作者：
DeLuca, S.;Sitara, D.;Kang, K.;Marsell, R.;Jonsson, K.;Taguchi, T.;Erben, R. G.;Razzaque, M. S.;Lanske, B.
通讯作者：
Lanske, B.
DOI：
10.2215/cjn.04720416
发表时间：
2017-02-01
影响因子：
9.8
作者：
Pasch, Andreas;Block, Geoffrey A.;Floege, Juergen
通讯作者：
Floege, Juergen
DOI：
10.2215/cjn.00810110
发表时间：
2010-12-01
影响因子：
9.8
作者：
Eddington, Helen;Hoefield, Richard;Kalra, Philip A.
通讯作者：
Kalra, Philip A.
影响因子：
15.9
作者：
Shalhoub, Victoria;Shatzen, Edward M.;Richards, William G.
通讯作者：
Richards, William G.
影响因子：
6
作者：
Sitara, Despina;Razzaque, Mohammed S.;Lanske, Beate
通讯作者：
Lanske, Beate