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Mineral and bone disorder management in hemodialysis patients: comparing PTH control practices in Japan with Europe and North America: the Dialysis Outcomes and Practice Patterns Study (DOPPS)

机译:血液透析患者中​​的矿物和骨紊乱管理:与欧洲和北美的日本第PH控制实践进行比较:透析结果和实践模式研究(DOPP)

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摘要

Abstract Background High-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality. Methods We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4–5 (2009–2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions (Europe/Australia/New Zealand [Eur/ANZ], Japan and North America) and dialysis vintage. Mortality rates were compared across PTH control categories using Cox regression models. Results Mean PTH was lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage  5% per month in Japan (48% of patients) versus Eur/ANZ (35%) and North America (35%). In patients with dialysis vintage > 1 year, Japanese patients maintained steady PTH, while patients in Eur/ANZ and North America were more likely to experience a PTH increase. Mean PTH was associated with mortality in the overall samples (highest mortality rate for PTH > 600 pg/mL, hazard ratio, 1.35; 95% confidence interval, 1.20 to 1.52 vs PTH 200–399 pg/mL), and the association was obvious in the prevalent patients (hazard ratio, 1.44; 95% confidence interval, 1.26 to 1.65). PTH slope and MSE did not show significant association with mortality in the overall sample as well as in subjects stratified both by region and dialysis vintage. Conclusion PTH control in hemodialysis patients, as measured by keeping a stable PTH level over 9 months, was observed in Japan contrasted with other regions. High PTH mean, but not increased PTH slope and MSE, was associated with mortality especially in prevalent patients.
机译:摘要背景甲状旁腺激素(PTH)的高循环水平与透析患者的升高的死亡率有关。日本透析治疗指南的社会表明,比其他国际指南的较低的PTH目标;因此,与其他地区相比,日本的第P4控制可能与死亡率相关。方法在透析结果和实践模式研究(DOPPS)阶段4-5(2009-2015)中,我们分析了血液透析患者≥3次PTH测量的血液透析患者的数据。通过所有PTH测量的平均值,斜坡和平均平方误差(MSE)评估PTH对照在9个月的运行期间。各地区(欧洲/澳大利亚/新西兰[EUR / ANZ],日本和北美)和透析复古评估每个第P结果的分布。使用COX回归模型将死亡率与PTH控制类别进行比较。结果意味着日本比在透析复古类别的其他地区较低。在日本每月5%的透析复古患者(患者的48%)与EUR / ANZ(35%)和北美(35%)。在透析葡萄酒患者中> 1年,日本患者保持稳定的PTH,而EUR / ANZ和北美的患者更有可能经历PTH增加。平均pth与总体样品中的死亡率有关(Pth> 600pg / ml的最高死亡率,危险比,1.35; 95%置信区间,1.20至1.52 Vs 200-399 pg / ml),并且关联显而易见在普遍的患者(危险比,1.44; 95%置信区间,1.26至1.65)。 PTH坡度和MSE在整个样本中没有显示出显着的联系,在整个样本中以及由地区和透析复古分层的受试者。结论日本观察到血液透析患者的第PTH对照血液透析患者,以超过9个月的稳定性PTH水平,与其他地区形成鲜明对比。高pth平均值,但不增加的pth斜坡和母版,尤其是在普遍患者中的死亡率有关。

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