关键词: 钙结合蛋白, 高磷血症, 血液透析, 死亡风险

Abstract:

Objective To investigate the correlation between serum calbindin（CPT） and the risk of all-cause death in hemodialysis patients with hyperphosphatemia. Methods Totally,373 continuous hemodialysis patients with hyperphosphatemia were enrolled. The baseline clinical data of all the patients [age,sex,body mass index（BMI）,ankle brachial index（ABI）,smoking history,combined diseases and so on] and clinical laboratory test data [white blood cell（WBC） count,high-sensitivity C-reactive protein（hs-CRP）,platelet（PLT）,albumin（Alb）,urea nitrogen,low-density lipoprotein cholesterol（LDL-C）,triglyceride（TG）] were collected. Serum CPT was determined. All the patients were classified into low CPT group,medium CPT group and high CPT group according to CPT levels. All the patients were followed up for 4-80 months. The endpoint of follow-up was death,renal transplantation or follow-up completion. Pearson correlation analysis was used to evaluate the correlation between various indexes and CPT levels. Cox regression analysis was used to evaluate the relationship between death risk and CPT level in hemodialysis patients. Results Serum CPT level of 373 continuous hemodialysis patients with hyperphosphatemia was 6.1（4.3-8.7） ng/L. Serum CPT in males was higher than that in females（P<0.01）. There was no statistical significance in serum CPT levels whether with smoking history,diabetes mellitus history,coronary artery disease history,stroke history and peripheral arterial disease history or not（P>0.05）. The results of correlation analysis showed that CPT was negatively correlated with dialysis time（r=-0.174,P<0.001）. It was positively correlated with BMI,WBC count,hs-CRP,PLT count and TG（r values were 0.192,0.553,0.378,0.329 and 0.270,P<0.05）,and there was no correlation with Alb and LDL-C（r values were 0.092 and -0.005,P>0.05）. Kaplan-Meier curve analysis indicated that the median survival time of patients in high CPT group was shorter than those in low and medium CPT groups（P<0.001）. Compared with medium CPT group,the risk of death in low CPT group decreased by 11% [hazard ratio（HR）=0.89,95% confidence interval（CI） 0.78-0.98,P=0.03] after adjusting for age,sex,BMI,hypertension history,diabetes mellitus history,dyslipidemia,dialysis time and smoking history. The risk of death increased by 70% in high CPT group（HR=1.70,95%CI 1.52-2.33,P=0.001）. Conclusions The level of serum CPT is related to the risk of death in hemodialysis patients with hyperphosphatemia.

Key words: Calbindin, Hyperphosphatemia, Hemodialysis, Risk of death