hyperparathyroidism had the highest symptom burden. Background Patients with advanced CKD develop numerous symptoms, with a multifactorial origin. Evidence linking mineral disorders (CKD-Mineral and Bone Disorder) and uremic symptoms is scant and mostly limited to dialysis patients. Here, we aim to assess the association between CKD-Mineral and Bone Disorder and symptom burden in nondialysis patients with CKD. Methods We used data from the European Quality study, which includes patients aged ≥65 years with eGFR ≤20 ml/min per 1.73 m2 from six European countries, followed up to 5 years. We used generalized linear mixed-effect models to determine the association between repeated measurements of parathyroid hormone (PTH), phosphate, and calcium with the overall symptom number (0–33), the overall symptom severity (0–165), and the presence of 33 CKD-related symptoms. We also analyzed subgroups by sex, age, and diabetes mellitus and assessed effect mediation and joint effects between mineral biomarkers. Results The 1396 patients included in the study had a mean of 13±6 symptoms at baseline, with a median overall severity score of 32 (interquartile range, 19–50). The association between PTH levels and symptom burden appeared U-shaped with a lower symptom burden found for mild-to-moderately increased PTH levels. Phosphate and calcium were not independently associated with overall symptom burden. The highest symptom burden was found in patients with a combination of both severe hyperparathyroidism and severe hyperphosphatemia (+2.44 symptoms [0.50–4.38], P = 0.01). The association of both hypocalcemia and hyperphosphatemia with symptom burden seemed to differ by sex and age. Conclusions In older patients with advanced CKD not on dialysis, mild-to-moderately increased PTH was associated with a lower symptom burden, although the effect size was relatively small (less than one symptom). Neither phosphate nor calcium were associated with the overall symptom burden, except for the combination of severe hyperphosphatemia and severe hyperparathyroidism which was associated with an increased number of symptoms....

中文翻译：

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慢性肾脏病 - 矿物质和骨骼疾病生物标志物与老年晚期慢性肾脏病患者症状负担之间的关联：EQUAL 研究的结果


甲状旁腺功能亢进症的症状负担最高。背景 晚期 CKD 患者会出现许多症状，这些症状起源于多因素。将矿物质紊乱（CKD-矿物质和骨骼紊乱）与尿毒症症状联系起来的证据很少，主要限于透析患者。在这里，我们旨在评估 CKD 矿物质与骨骼疾病以及 CKD 非透析患者症状负担之间的关联。方法 我们使用了欧洲质量研究的数据，其中包括来自 6 个欧洲国家的 ≥65 岁 eGFR ≤20 ml/min /1.73 m2 的患者，随访长达 5 年。我们使用广义线性混合效应模型来确定甲状旁腺激素 （PTH） 、磷酸盐和钙的重复测量与总体症状数 （0-33） 、总体症状严重程度 （0-165） 和 33 种 CKD 相关症状的存在之间的关联。我们还按性别、年龄和糖尿病分析了亚组，并评估了矿物生物标志物之间的效应中介和联合效应。结果 研究纳入的 1396 名患者基线时平均有 13±6 种症状，总体严重程度评分中位数为 32 分（四分位距，19-50）。PTH 水平与症状负担之间的关联呈 U 形，轻度至中度增加的 PTH 水平的症状负担较低。磷酸盐和钙与总体症状负担不独立相关。在重度甲状旁腺功能亢进症和重度高磷血症患者中，症状负担最高（+2.44个症状[0.50–4.38]，P=0.01）。低钙血症和高磷血症与症状负担的相关性似乎因性别和年龄而异。 结论 在未接受透析的老年晚期 CKD 患者中，轻度至中度增加的 PTH 与较低的症状负担相关，尽管效应量相对较小 （少于一个症状）。磷酸盐和钙与总体症状负担无关，除了严重的高磷血症和严重的甲状旁腺功能亢进症的结合与症状数量增加有关。