Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: The USRDS waves 1, 3, and 4 study
Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: The USRDS waves 1, 3, and 4 study
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DOI：
10.1681/asn.2004040275
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发表时间：
2005-06-01
影响因子：
13.6
通讯作者：
Collins, AJ
中科院分区：
文献类型：
--
作者：
Slinin, Y;Foley, RN;Collins, AJ
动物研究表明，钙磷平衡异常会导致尿毒症的心血管疾病；很少有人类的观察性研究探索这一点。对1993年12月31日14,829名血液透析患者进行了美国肾脏数据系统第1、3、4波的回顾性研究。肾脏替代治疗的平均年龄和持续时间分别为60.0岁和3.2年；40.7%的患者有糖尿病。(经白蛋白调整的)钙的五分位数(Q(1)至Q(5))为10.2 mg/dl；磷为7.5 mg/dl；钙磷乘积为71.0 mg(2)/dl；甲状旁腺激素(PTH)为480 pg/ml。较高的钙水平与致命性或非致命性心血管事件(调整后的危险比Q(5)为1.08，Q(1))和全因死亡率(Q(2)，1.07；Q(4)，1.11；Q(5)，1.14)。磷水平与心血管事件相关(Q(2)，1.06；Q(3)，1.13；Q(4)，1.14；Q(5)，1.25)和死亡率Q(4)，1.10；Q(5)，1.19)，钙磷乘积与心血管事件Q(3)，1.09；Q(4)，1.14；Q(5)，1.24；死亡率(Q(4)，1.09；甲状旁腺素水平与心血管事件(Q(5)，1.12)和死亡率(Q(5)，1.17)相关。尽管有局限性(包括回顾性设计；非当前研究时代；缺乏连续的钙、磷和甲状旁腺素测定)，但该研究表明，钙稳态失调与血液透析患者的致命性和非致命性心血管事件和全因死亡率有关。
Animal studies suggest that calcium-phosphorus homeostatic abnormalities cause cardiovascular disease in uremia; few observational studies in humans have explored this. Associations in the retrospective United States Renal Data System Waves 1, 3, and 4 Study of 14,829 patients who were on hemodialysis on December 31, 1993, were examined. Mean age and duration of renal replacement therapy were 60.0 and 3.2 yr, respectively; 40.7% had diabetes. Quintiles (Q(1) to Q(5)) of (albumin-adjusted) calcium were 10.2 mg/dl; phosphorus, 7.5 mg/dl; calcium-phosphorus product, 71.0 mg(2)/dl(2); and parathyroid hormone (PTH), 480 pg/ml. Higher calcium levels were associated with fatal or nonfatal cardiovascular events (adjusted hazards ratio, 1.08 for Q(5), versus Q(1)) and all-cause mortality (Q(2), 1.07; Q(4), 1.11; Q(5), 1.14). Phosphorus levels were associated with cardiovascular events (Q(2), 1.06; Q(3), 1.13; Q(4), 1.14; Q(5), 1.25) and mortality Q(4), 1.10; Q(5), 1.19), calcium-phosphorus product was associated with cardiovascular events Q(3), 1.09; Q(4), 1.14; Q(5), 1.24) and mortality (Q(4), 1.09; Q(5), 1.19), and PTH levels were associated with cardiovascular events (Q(5), 1.12) and mortality (Q(5), 1.17). Despite limitations (including retrospective design; noncurrent study era; and lack of serial calcium, phosphorus, and PTH measurements), this study suggests that disorders of calcium homeostasis are associated with fatal and nonfatal cardiovascular events and all-cause mortality in hemodialysis patients.