The kidney disease outcomes quality initiative (K/DOQI) guideline for bone metabolism and disease in CKD: Association with mortality in dialysis patients
The kidney disease outcomes quality initiative (K/DOQI) guideline for bone metabolism and disease in CKD: Association with mortality in dialysis patients
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DOI：
10.1053/j.ajkd.2005.08.013
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发表时间：
2005-11-01
影响因子：
13.2
通讯作者：
Krediet, RT
中科院分区：
文献类型：
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作者：
Noordzij, M;Korevaar, JC;Krediet, RT
背景2003年，美国国家肾脏基金会-肾脏疾病结局质量倡议（K/DOQI）发布了一项指南，建议严格控制慢性肾脏疾病患者的血清钙、磷、钙磷乘积（Ca x P）和完整甲状旁腺激素水平。在本指南的背景下，我们探讨了这些血浆浓度与荷兰透析患者全因死亡风险的相关性。研究方法：在一项大型、前瞻性、多中心、队列研究（荷兰透析成功率合作研究）中，我们纳入了1997年至2004年期间新接受血液透析或腹膜透析治疗的1，629例患者。多变量考克斯回归模型包括钙水平、磷水平、全段甲状旁腺激素水平、年龄、合并症、原发性肾脏疾病、营养状况、白蛋白水平、透析剂量和血红蛋白水平，用于检查死亡风险。结果：平均年龄为60 ± 15（SD）岁，61%为男性，64%接受血液透析治疗。在校正的时间依赖生存分析中，血磷水平高于目标值时，血液透析患者的全因死亡风险增加40%（风险比[HR]，1.4; 95%置信区间[CI]，1.1 - 1.7），腹膜透析患者的全因死亡风险增加60%（HR，1.6; 95% CI，1.1 - 2.4）。此外，血浆Ca x P产物水平升高使血液透析患者的死亡风险增加40%（HR，1.4; 95% CI，1.1至1.8），腹膜透析患者的死亡风险增加50%（HR，1.5; 95% CI，1.0至2.2）。在两个患者组中，未观察到血浆水平低于目标的显著影响。结论：在时间依赖性生存分析中，血磷和Ca x P产物浓度高于K/DOQI目标的存在增加了血液透析和腹膜透析患者的全因死亡风险。
Background In 2003, the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (K/DOQI) published a guideline recommending tight control of serum calcium, phosphorus, calcium-phosphorus product (Ca x P), and intact parathyroid hormone levels in patients with chronic kidney disease. Within the context of this guideline, we explored associations of these plasma concentrations with all-cause mortality risk in incident dialysis patients in The Netherlands. Methods: In a large, prospective, multicenter, cohort study (Netherlands Cooperative Study on the Adequacy of Dialysis), we included 1,629 patients new on hemodialysis or peritoneal dialysis therapy between 1997 and 2004. Multivariate Cox regression models containing calcium level, phosphorus level, intact parathyroid hormone level, age, comorbidity, primary kidney disease, nutritional status, albumin level, dialysis dose, and hemoglobin level were used to examine mortality risks. Results: Mean age was 60 +/- 15 (SD) years, 61% were men, and 64% were treated with hemodialysis. In adjusted time-dependent survival analysis, all-cause mortality risk increased in hemodialysis patients by 40% (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and in peritoneal dialysis patients by 60% (HR, 1.6; 95% Cl, 1.1 to 2.4) for plasma phosphorus levels greater than the target. In addition, having elevated plasma Ca x P product levels increased mortality risk by 40% (HR, 1.4; 95% CI, 1.1 to 1.8) in hemodialysis patients and 50% in peritoneal dialysis patients (HR, 1.5; 95% CI, 1.0 to 2.2). In both patient groups, no significant effects were observed for plasma levels less than the targets. Conclusion: In time-dependent survival analysis, the presence of plasma phosphorus and Ca x P product concentrations greater than K/DOQI targets increased all-cause mortality risk in hemodialysis and peritoneal dialysis patients.