論文

査読有り 国際誌
2019年8月5日

Population-level associations of achievement of targets for bone-mineral markers with survival in haemodialysis patients with mildly elevated intact-PTH levels: a case-cohort study.

Scientific reports
  • Shingo Fukuma
  • ,
  • Shunichi Fukuhara
  • ,
  • Sayaka Shimizu
  • ,
  • Tadao Akizawa
  • ,
  • Masafumi Fukagawa

9
1
開始ページ
11301
終了ページ
11301
記述言語
英語
掲載種別
DOI
10.1038/s41598-019-47852-8

Achieving calcium, phosphorus, and intact parathyroid hormone (PTH) targets helps improve dialysis population outcomes. We aimed to assess the population-level associations of achievement of those targets with survival using population-attributable-fractions (PAFs). We conducted a case-cohort study using data from 8229 haemodialysis patients with mildly elevated intact PTH, treated at 86 dialysis facilities in Japan. We examined associations among calcium, phosphorus, intact PTH, and mortality over 3 years. We estimated PAFs for achieving the targets of calcium, phosphorus, and intact PTH from the adjusted hazard ratios by Cox regression models. Proportions within the recommended range were 55.8%, 63.3%, and 39.1% for calcium (8.4-10.0 mg/dL), phosphorus (3.5-6.0 mg/dL) and intact PTH (60-240 pg/mL), respectively. The mortality rate was 5.7 per 100 person-years. Mortality was independently associated with non-achievement of targets. Regarding the population-level impact, statistically significant PAFs were found for achieving the combination of calcium and phosphorus (8.8%; 95% CI, 1.1-16.0). Further, PAF for combined calcium, phosphorus, and intact PTH was the largest (16.8%; 95% CI, 5.6-30.4). In conclusion, there might be additive and substantial population-level associations between survival and the achievement of calcium, phosphorus, and intact-PTH targets in the haemodialysis population with mildly elevated intact PTH.

リンク情報
DOI
https://doi.org/10.1038/s41598-019-47852-8
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/31383933
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683189