Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients.
Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients.
复制标题
DOI：
10.1053/j.jrn.2009.10.006
复制
发表时间：
2010-07
期刊：
影响因子：
--
通讯作者：
Kalantar-Zadeh K
中科院分区：
文献类型：
--
作者：
Dukkipati R;Kovesdy CP;Colman S;Budoff MJ;Nissenson AR;Sprague SM;Kopple JD;Kalantar-Zadeh K
低血清甲状旁腺激素（PTH）已被认为是慢性肾病（CKD）患者接受维持性血液透析（MHD）治疗时发生粘连性骨病的主要生化标志物。我们假设营养不良-炎症复合体与这些患者的低PTH水平相关，并混淆了PTH-生存相关性。我们在南加州检查了748例稳定的MHD门诊患者，并对他们进行了长达5年的随访（10/2001-12/2006）。在748例MHD患者中，血清PTH <150 pg/ml在非黑人和糖尿病患者中更为普遍。血清PTH与冠状动脉钙化评分、骨密度、膳食蛋白质或热量摄入之间无相关性。低血清甲状旁腺激素与蛋白质-能量消耗和炎症标志物相关，这种相关性混淆了血清甲状旁腺激素和碱性磷酸酶之间的关系。尽管不同PTH增量的5年粗死亡率相似，但在调整病例组合以及营养不良和炎症的替代因素后，与其他血清PTH水平相比，100至150 pg/ml范围内的中度低血清PTH与最大生存率相关，即，与PTH为300 - 600 pg/ml（参考）相比，死亡风险比为0.52（95%置信区间：0.29-0.92，p<0.001）。低血清PTH可能是CKD中营养不良-炎症复合体的另一个方面，在控制了该混杂因素后，100至150 pg/ml范围内的中度低PTH似乎与最高生存率相关。应考虑观察性研究的局限性。
Low serum parathyroid hormone (PTH) has been implicated as a primary biochemical marker of adynamic bone disease in individuals with chronic kidney disease (CKD) who undergo maintenance hemodialysis (MHD) treatment. We hypothesized that the malnutrition-inflammation complex is associated with low PTH levels in these patients and confounds the PTH-survival association. We examined 748 stable MHD outpatients in Southern California and followed them for up to 5 years (10/2001-12/2006). In 748 MHD patients, serum PTH <150 pg/ml was more prevalent among non-Blacks and diabetics. There was no association between serum PTH and coronary artery calcification score, bone mineral density or dietary protein or calorie intake. Low serum PTH was associated with markers of protein-energy wasting and inflammation, and this association confounded the relationship between serum PTH and alkaline phosphatase. Although 5-year crude mortality rates were similar across PTH increments, after adjustment for the case-mix and surrogates of malnutrition and inflammation, a moderately low serum PTH in 100 to 150 pg/ml range was associated with the greatest survival compared to other serum PTH levels, i.e., a death hazard ratio of 0.52 (95% confidence interval: 0.29-0.92, p<0.001) compared to PTH of 300 to 600 pg/ml (reference). Low serum PTH may be another facet of the malnutrition-inflammation complex in CKD, and after controlling for this confounder, a moderately low PTH in 100 to 150 pg/ml range appears associated with the greatest survival. Limitations of observational studies should be considered.
登录
查看更多内容
影响因子：
13.2
作者：
Bologa, RM;Levine, DM;Rubin, AL
通讯作者：
Rubin, AL
影响因子：
19.6
作者：
Haris, A.;Sherrard, D. J.;Hercz, G.
通讯作者：
Hercz, G.
影响因子：
6.1
作者：
Dobrez, DG;Mathes, A;Sprague, SM
通讯作者：
Sprague, SM
影响因子：
6.2
作者：
Gal-Moscovici, Arica;Sprague, Stuart M.
通讯作者：
Sprague, Stuart M.
影响因子：
3.2
作者：
Colman, S;Bross, R;Kalantar-Zadeh, K
通讯作者：
Kalantar-Zadeh, K