Optimal targets of chronic kidney disease-mineral and bone disorder markers for Chinese patients with maintenance peritoneal dialysis: a single-center retrospective cohort study.
Optimal targets of chronic kidney disease-mineral and bone disorder markers for Chinese patients with maintenance peritoneal dialysis: a single-center retrospective cohort study.
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DOI：
10.1080/0886022x.2022.2041438
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发表时间：
2022-12
期刊：
影响因子：
3
通讯作者：
Li X
中科院分区：
文献类型：
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作者：
Chen L;Tang X;Zheng H;Wang H;Xia P;Wang Y;Zhao X;Zhou Z;Qiu L;Li X
已知慢性肾脏疾病-矿物质和骨疾病（CKD-MBD）与透析患者死亡率增加相关，但目前主要从血液透析中制定的CKD-MBD全球指南是否适用于腹膜透析（PD）患者的实践需要进一步研究。这是一项单中心回顾性队列研究。共纳入了2004年1月至2017年12月期间来自北京协和医院的491例PD患者（中位随访时间：34个月），并随访至2018年6月30日。在考克斯比例回归模型中，透析第一年的平均血清钙、白蛋白校正钙（CorCa）、磷和甲状旁腺激素（PTH）水平是感兴趣的预测因素。在这些PD患者（年龄58 ± 17岁）中，52%为男性，36%患有糖尿病肾病。在对第一年平均参数的考克斯回归分析中，与PTH 100-200 pg/mL相比，PTH <100 pg/mL（HR = 1.97，95% CI 1.32 - 2.94，p < 0.001）和≥300 pg/mL（HR = 2.24，95% CI 1.32 - 3.81，p = 0.003）与全因死亡率增加相关。白蛋白校正血清钙水平< 2.13 mmol/L的患者死亡风险也高于2.13 - 2.38 mmol/L的患者（HR = 2.06，95% CI 1.06 - 4.01，p = 0.02）。血磷≥1.45 mmol/L与全因死亡率增加相关。然而，缺乏25-羟基维生素D，碱性磷酸酶和活性维生素D的数据是我们分析的局限性。作为最大的PD队列研究之一，重点是CKD-MBD，我们证明了在PD的第一年CKD-MBD标志物的水平是全因死亡率的独立预测因子。PTH 100-300 pg/mL可能是中国PD患者的最佳治疗目标。
The chronic kidney disease-mineral and bone disorder（CKD-MBD) is known to be associated with increased mortality in dialysis patients, but whether current global guidelines for CKD-MBD, which were primarily developed from hemodialysis, are suitable for peritoneal dialysis (PD) patients practice require further investigation. This is a single-center retrospective cohort study. In total 491 prevalent PD patients (median follow-ups: 34 months) from Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2017 were included and followed until 30 June 2018. In the first dialysis year, the average levels of serum calcium, albumin-corrected calcium (CorCa), phosphorus, and parathyroid hormone (PTH) levels were the interested predictors in Cox proportional regression model. Of these PD patients (age 58 ± 17 years), 52% were male and 36% had diabetic nephropathy. In Cox regression over first-year mean parameters, PTH <100 pg/mL (HR = 1.97, 95% CI 1.32 to 2.94, p < 0.001) and ≥300 pg/mL (HR = 2.24, 95% CI 1.32 to 3.81, p = 0.003) were associated with increased all-cause mortality than that of PTH 100–200 pg/mL. Patients with albumin-corrected serum calcium level < 2.13 mmol/L also had higher risk of death than patients with level of 2.13 to 2.38 mmol/L (HR = 2.06, 95% CI 1.06 to 4.01, p = 0.02). Serum phosphorus ≥1.45 mmol/L were associated with increased all-cause mortality. However, lacking of data on 25-hydroxy vitamin D, alkaline phosphatase, and activated vitamin-D are limitations of our analysis. As one of the largest PD cohort study focusing on CKD-MBD, we demonstrated that the level of CKD-MBD markers in the first PD year are independent predictors of all-cause mortality. PTH 100–300 pg/mL might be the best target for Chinese PD patients.
影响因子：
3.7
作者：
Lin YC;Lin YC;Hsu CY;Kao CC;Chang FC;Chen TW;Chen HH;Hsu CC;Wu MS;Taiwan Society of Nephrology
通讯作者：
Taiwan Society of Nephrology
影响因子：
--
作者：
Liu Y;Lee WC;Cheng BC;Li LC;Lee CH;Chang WX;Chen JB
通讯作者：
Chen JB