| ObjectiveTo investigate the effect of changes in serum intact parathyroid hormone level(?iPTH)in maintenance hemodialysis patients within 6 months on prognosis within the next 2 years,so as to better guide the clinical prevention and treatment of maintenance hemodialysis patients.MethodsA prospective,observational,single-center,routine clinical practice was used.The clinical data of 129 MHD patients in the hemodialysis center of the First Affiliated Hospital of Dali University from September 2016(baseline value)to March 2017(6 months value)were collected and divided into ?iPTH(27)0 pg/mL group and ?iPTH?0 pg/mL group according to the changes of iPTH in 6 months.?iPTH was 6 months iPTH value minus baseline iPTH value.Follow-up until March 20,2019,dialysis-relevant information was collected such as complications during dialysis,prognosis and etc,and evaluate the impact of iPTH on clinical prognosis of patients.Survival analysis was performed by Kaplan-Meier method and log-rank test.Mortality risk was analyzed by single-factor and multi-factor Cox regression models.Results1.A total of 123 MHD patients were enrolled the final study.Males 64.2% and 44 female 35.8%,with an average age of 48.74 ± 13.55 years and a dialysis age of 30(14,43)months.The primary disease was chronic glomerulonephritis 64.2%,diabetic nephropathy 11.4%,and etc.2.Median baseline iPTH level were 269.38(136.80,599.40)pg/mL.?iPTH between baseline and 6 months later was 94.95 ± 199.18 pg/mL(median ?iPTH was 62.80(-10.90,184.20)pg/mL).3.During the two-year follow-up period,22 patients died,with an annual mortality rate of 11.3%.26 patients were censored during the two-year follow-up period.22 deaths during the follow-up period included 10(45.5%)cardiovascular and cerebrovascular events,1(4.5%)tumor events,3(13.6%)infectious events,1(4.5%)gastrointestinal bleeding and 7(31.8%)unknown causes.4.?iPTH was significantly higher in patients who survived than in those who died(101.52 ± 179.64 pg/mL vs 33.46 ± 125.32 pg/mL,P=0.033),but baseline iPTH values were not significantly different between the two groups.5.Kaplan-Meier survival curve showed that the survival rate of ?iPTH ?0 group was significantly higher than that of ?iPTH <0 group(P=0.027).?iPTH as a four-category variable,we divided ?iPTH into four groups.The highest mortality rate(35.5%(11/31))was observed in patients with ?iPTH <0 pg/mL group.Compared with with ?iPTH <0 group,the mortality rate of 100? ?iPTH(27)300 group was the lowest(11.1%(3/27),P=0.030).6.The multivariate Cox regression analysis showed that for every 1 pg/mL increase of ?iPTH,the risk of mortality was reduced by 0.3%(RR=0.997,95%CI: 0.994-1.000,P=0.052);compared with ?iPTH(27)0 group,the mortality risk of ?iPTH?0 group was reduced by 69.7%(RR=0.303,95%CI: 0.111-0.824,P=0.019)and the mortality risk of 100? ?iPTH(27)300 group was reduced by 82.9%(RR=0.171,95%CI: 0.041-0.712,P= 0.015).7.Multivariate Cox regression analysis indicated that the risk of mortality was RR=2.861(95%CI: 1.066-7.676,P=0.037)in the group with cardio-cerebrovascular disease compared with the group without cardio-cerebrovascular disease;the risk of mortality was increased by 4.3% for every month of dialysis age(RR=1.043,95%CI: 1.020-1.067,P(27)0.001);the risk of mortality increased by 8.9% for every 1 umol/L of TIBC(RR=1.089,95%CI: 1.045-1.136,P(27)0.001).8.In MHD patients whose primary disease was chronic glomerulonephritis,the increase of ?iPTH was a higher survival rate.The multivariate Cox regression analysis showed that compared with MHD patients whose primary disease was chronic glomerulonephritis of ?iPTH(27)0 group,the mortality risk in ?iPTH?0 group was reduced by 67.5%(RR=0.325,95%CI: 0.070-1.507,P=0.151).9.During the two-year follow-up period,341 cases of various clinical events occurred,including 84 cases of cardio-cerebrovascular events(24.6%),22 cases of hypotension during dialysis(6.5%),26 cases of access events(7.6%),67 cases of infection(19.6%),and ect.The logistic regression analysis showed that iPTH?0 pg/mL was a protective factor for the occurrence of respiratory infections in MHD patients(OR=0.358,95%CI: 0.148-0.864,P=0.022).Conclusion1.In maintenance hemodialysis patients with median baseline of iPTH values within the recommended range of K/DOQI guidelines,the increase of ?iPTH was associated with lower mortality rate,and the lowest mortality rate was observed in patients with 100? ?iPTH(27)300 pg/mL.2.?iPTH(27)0 pg/mL was a risk factor for increased mortality in maintenance hemodialysis patients.For every 1 pg/mL increase of ?iPTH,the risk of mortality was reduced by 0.3%.Compared with ?iPTH(27)0 group,the mortality risk of ?iPTH?0 group was reduced by 69.7%,suggesting that in routine clinical practice,attention should be paid to prevent excessive inhibition of the level of iPTH in HD patients,so that the increase of iPTH may be safer than the decrease of iPTH.3.Complication of cardio-cerebrovascular diseases,long dialysis age and high level of TIBC are risk factors for increased mortality in MHD patients. |
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