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首页> 外文期刊>Kidney international supplements. >Hyperphosphatemia is a combined function of high serum PTH and high dietary protein intake in dialysis patients
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Hyperphosphatemia is a combined function of high serum PTH and high dietary protein intake in dialysis patients

机译：高渗血症是透析患者高血清PTH和高膳食蛋白摄入量的组合功能

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Elevated serum phosphorus is associated with higher death risk in hemodialysis patients. Previous studies have suggested that both higher serum parathyroid hormone (PTH) level and higher dietary protein intake may contribute to higher serum phosphorus levels. However, it is not well known how these two factors simultaneously contribute to the combined risk of hyperphosphatemia in real patient-care scenarios. We hypothesized that the likelihood of hyperphosphatemia increases across higher serum PTH and higher normalized protein catabolic rate (nPCR) levels, a surrogate of protein intake. Over an 8-year period (July 2001-June 2009), we identified 69,355 maintenance hemodialysis patients with PTH, nPCR, and phosphorus data in a large dialysis provider. Logistic regression models were examined to assess the association between likelihood of hyperphosphatemia (serum phosphorus 45.5mg/dl) and serum PTH and nPCR increments. Patients were 61 +/- 15 years old and included 46% women, 33% blacks, and 57% diabetics. Both higher serum PTH level and higher protein intake were associated with higher risk of hyperphosphatemia in dialysis patients. Compared with patients with PTH level 150- 600 pg/ml and nPCR>1.2 g/kg/day had a threefold higher risk of hyperphosphatemia (OR: 3.17, 95% CI: 2.69-3.75). Hyperphosphatemia is associated with both higher dietary protein intake and higher serum PTH level in maintenance hemodialysis patients. Worsening or resistant hyperphosphatemia may be an under-appreciated consequence of secondary hyperparathyroidism independent of dietary phosphorus load. Management of hyperphosphatemia should include diligent correction of hyper-parathyroidism while maintaining adequate intake of high protein foods with low phosphorus content.
机译：血清磷的升高与血液透析患者的死亡风险有关。以前的研究表明，血清甲状旁腺激素（PTH）水平和更高的膳食蛋白摄入可能有助于血清磷水平。然而，尚不众所周知，这两个因素如何同时导致真正的患者护理场景中高渗血症的综合风险。我们假设高磷脂血症的可能性在较高的血清PTH和较高的归一化蛋白分解代谢率（NPCR）水平上增加，蛋白质摄入的替代品。在8年期（2001年7月 - 2009年7月）中，我们确定了69,355名患有Pth，NPCR和大型透析提供者中的磷数据的血液透析患者。研究了物流回归模型，以评估高磷脂血症（血清磷45mg / DL）和血清PTH和NPCR增量之间的关联。患者61岁+/- 15岁，包括46％的女性，33％的黑人和57％的糖尿病患者。血清PTH水平和较高的蛋白质摄入量均与透析患者的高磷血症的风险较高有关。与第150-600 pg / ml和NPCR患者的患者进行比较，NPCR> 1.2g / kg /天具有更高的高磷血症风险（或：3.17,95％CI：2.69-3.75）。高磷血症与血液透析患者的较高膳食蛋白摄入和更高的血清PTH水平有关。恶化或抗性的高磷血症可能是次级甲状旁腺功能亢进的不受理智的结果，与膳食磷荷载无关。高磷脂血症的管理应包括对超甲状甲虫的勤奋矫正，同时保持具有低磷含量的高蛋白质食物的充分摄入量。

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