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首页> 外文OA文献 >Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3
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Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3

机译：慢性肾脏病3期患者的前瞻性初级保健队列中成纤维细胞生长因子23，维生素D和甲状旁腺激素与5年结局的关系

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Objectives Vitamin D deficiency, elevated fibroblast growth factor 23 (FGF23) and elevated parathyroid hormone (PTH) have each been associated with increased mortality in people with chronic kidney disease (CKD). Previous studies have focused on the effects of FGF23 in relatively advanced CKD. This study aims to assess whether FGF23 is similarly a risk factor in people with early CKD, and how this risk compares to that associated with vitamin D deficiency or elevated PTH.ududDesign Prospective cohort study.ududSetting Thirty-two primary care practices.ududParticipants One thousand six hundred and sixty-four people who met Kidney Disease: Improving Global Outcomes (KDIGO) definitions for CKD stage 3 (two measurements of estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m2 at least 90 days apart) prior to study recruitment.ududOutcome measures All-cause mortality over the period of study follow-up and progression of CKD defined as a 25% fall in eGFR and a drop in GFR category, or an increase in albuminuria category.ududResults Two hundred and eighty-nine participants died during the follow-up period. Vitamin D deficiency (HR 1.62, 95% CI 1.01 to 2.58) and elevated PTH (HR 1.42, 95% CI 1.09 to 1.84) were independently associated with all-cause mortality. FGF23 was associated with all-cause mortality in univariable but not multivariable analysis. Fully adjusted multivariable models of CKD progression showed no association with FGF23, vitamin D status or PTH.ududConclusions In this cohort of predominantly older people with CKD stage 3 and low risk of progression, vitamin D deficiency and elevated PTH were independent risk factors for all-cause mortality but elevated FGF23 was not. While FGF23 may have a role as a risk marker in high-risk populations managed in secondary care, our data suggest that it may not be as important in CKD stage 3, managed in primary care.
机译：目的维生素D缺乏症，成纤维细胞生长因子23（FGF23）升高和甲状旁腺激素（PTH）升高均与慢性肾脏病（CKD）患者的死亡率增加有关。先前的研究集中于FGF23在相对晚期CKD中的作用。这项研究旨在评估FGF23是否是早期CKD患者的类似危险因素，以及与维生素D缺乏症或PTH升高相关的危险如何。 ud ud设计前瞻性队列研究。 ud ud设置三十二项主要研究参与者164名患有肾脏疾病的人：改善CKD第3阶段的总体预后（KDIGO）定义（两次测量估计的肾小球滤过率（eGFR）在30至60 mL / min之间/ ud ud结果测量：研究随访和CKD进展期间的全因死亡率定义为eGFR下降25％，GFR类别下降， ud ud结果随访期间有289名参与者死亡。维生素D缺乏症（HR 1.62，95％CI 1.01至2.58）和PTH升高（HR 1.42，95％CI 1.09至1.84）与全因死亡率相关。在单变量而非多变量分析中，FGF23与全因死亡率相关。完全调整的CKD进展的多变量模型显示与FGF23，维生素D状态或PTH没有关系。 ud ud结论在这一主要为CKD 3期，低进展风险，维生素D缺乏和PTH升高的老年人中，这是独立的危险因素所有原因的死亡率，但FGF23并未升高。尽管FGF23可能在二级保健中管理的高危人群中作为危险标志物起作用，但我们的数据表明，它在CKD第三阶段（在初级保健中管理）中可能不那么重要。

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