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首页> 外文期刊>American Journal of Kidney Diseases: The official journal of the National Kidney Foundation >Disordered mineral metabolism in hemodialysis patients: an analysis of cumulative effects in the Hemodialysis (HEMO) Study.
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Disordered mineral metabolism in hemodialysis patients: an analysis of cumulative effects in the Hemodialysis (HEMO) Study.

机译：血液透析患者的矿物质代谢紊乱：血液透析（HEMO）研究中累积效应的分析。

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BACKGROUND: Serum markers of disordered mineral metabolism have been associated with adverse outcomes in patients requiring long-term dialysis therapy. Although the values of these markers often evolve over time, no study has examined the accumulated effects of these abnormalities on important clinical end points. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 1,846 prevalent hemodialysis patients randomly assigned in the Hemodialysis (HEMO) Study. PREDICTORS: Serum phosphorus, calcium, calcium-phosphorus (Ca x P) product, and intact parathyroid hormone, each analyzed at the time of randomization (baseline), as a standard time-dependent covariate and as a cumulative time-dependent covariate. OUTCOMES: All-cause mortality and the composite of all-cause mortality and first cardiac hospitalization. MEASUREMENTS: Cox proportional hazards models. RESULTS: In all analyses, serum phosphorus level greater than 6 mg/dL was associated with a heightened risk of mortality of approximately 25% compared with phosphorus values of 4.1 to 5 mg/dL. Serum calcium level greater than 11 mg/dL was associated with a 60% greater risk of death, but only when this parameter was analyzed as either a time-dependent or cumulative time-dependent variable. Ca x P product greater than 50 mg(2)/dL(2) was strongly associated with mortality, but only when assessed cumulatively. Similar relationships were observed when phosphorus, calcium, and Ca x P product values were related to the composite end point of all-cause mortality and first cardiac hospitalization. No relationships between baseline, time-dependent, and cumulative time-dependent intact parathyroid hormone levels and the outcomes of interest were observed. LIMITATIONS: Residual confounding, lack of access to patient information before randomization in the HEMO Study, and concerns regarding generalizability given changes in practice patterns since the completion of the HEMO Study. CONCLUSIONS: Cumulative time-dependent analyses provide a different framework foranalyzing the impact of factors that may mediate adverse events in hemodialysis patients. Our findings support maintaining serum phosphorus levels at less than 6 mg/dL, calcium levels at less than 11 mg/dL, and Ca x P product at less than 50 mg(2)/dL(2).
机译：背景：需要长期透析治疗的患者中，矿物质代谢紊乱的血清标志物已与不良预后相关。尽管这些标志物的值通常随时间变化，但尚无研究检查这些异常对重要临床终点的累积影响。研究设计：回顾性队列研究。地点和参与者：1846名在血液透析（HEMO）研究中随机分配的血液透析患者。预测：血清磷，钙，钙磷（Ca x P）产物和完整的甲状旁腺激素，均在随机化时（基线）进行分析，作为标准的时间依赖性协变量和累积的时间依赖性协变量。结果：全因死亡率和全因死亡率与首次心脏病住院的综合。度量：Cox比例风险模型。结果：在所有分析中，血清磷水平高于6 mg / dL时死亡率升高约25％，而磷值为4.1至5 mg / dL。血清钙水平高于11 mg / dL与死亡风险增加60％相关，但仅当将此参数作为时间相关变量或累积时间相关变量进行分析时。 Ca x P大于50 mg（2）/ dL（2）的产品与死亡率密切相关，但仅当进行累积评估时才如此。当磷，钙和Ca x P乘积值与全因死亡率和首次心脏病住院的复合终点相关时，观察到相似的关系。没有观察到基线，时间依赖性和累积时间依赖性完整甲状旁腺激素水平与目标结果之间的关系。局限性：在HEMO研究中，残余混杂，在随机化之前无法获得患者信息，以及自从完成HEMO研究以来实践模式的变化，对普遍性的担忧。结论累积的时间依赖性分析为分析可能介导血液透析患者不良事件的因素的影响提供了不同的框架。我们的发现支持将血清磷水平维持在6 mg / dL以下，将钙水平维持在11 mg / dL以下，将Ca x P产物维持在50 mg（2）/ dL（2）以下。

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