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- OpenAccess
Time-Average Serum Phosphate Predicts Cardiovascular Events in Hemodialysis Patients: An Observational Cohort Study
並列摘要
Mineral and bone disease (CKD-MBD) and imbalance of serum phosphate (P), calcium (Ca) and parathyroid hormone (PTH) are associated with all cause mortality and cardiovascular disease. However, these studies examine the association between mineral values and mortality with only baseline values. OBJECTIVES: This study examines the associations among mineral values (Ca, P and PTH), cardiovascular events and mortality from a single medical center using baseline and time-average model. METHODS: Adult patients who initiate hemodialysis in Taoyuan General Hospital from January 2008 to December 2013 were enrolled. We examined the association among mineral values (Ca, P, and PTH), cardiovascular events and mortality using baseline and time-average model. The cardiovascular events include nonfatal myocardial infarction, coronary insuffi ciency, stroke, transient ischemic attack, peripheral arterial occlusive disease with claudication, and acute decompensated heart failure. We also examined the association between achieve K/DOQI guidelines’ targets and all cause mortality as well as cardiovascular events. RESULTS: From a total of 273 hemodialysis patients, none of the baseline mineral values is associated with mortality and cardiovascular event, except hyperphosphatemia. Compared to patients achieved K/DOQI guidelines’ targets, the HRs for mortality in hyperphosphatemia (＞5.5 mg/dL), hypercalcemia (＞9.5 mg/dL), and hyperparathyroidism (＞300 pg/mL) are 2.317, 1.681 and 0.561 (all Ps ＞ 0.05) respectively, whereas those for cardiovascular event are 3.278, 1.860 and 1.782 (＂P＂=0.012, 0.274, and 0.311). The HRs for mortality in those who only met PTH targets and none of the mineral values targets are 1.73 and 1.74, whereas the hazard ratios for cardiovascular events in those who met only Ca, only PTH, and none of the target are 1.73, 1.81 and 2.54 (all ＂Ps＂＜0.05). CONCLUSION: Time-average phosphate is associated with cardiovascular events after initiation of dialysis. Among mineral values, serum phosphate is still the strongest predictor for mortality and cardiovascular events.
延伸閱讀
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