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Abstract：
Secondary hyperparathyroidism (SHPT) can progress to severe SHPT (sSHPT), which affects the survival rate and quality of life of patients. This retrospective cohort study investigated risk factors for sSHPT and the association between SHPT and mortality (all-cause and infection-related) among 771 clinically stable patients (421 male patients; mean age, 51.2 years; median dialysis vintage, 28.3 months) who underwent >3 months of regular peritoneal dialysis (PD) between January 2013 and March 2021. The sSHPT and non-sSHPT groups comprised 75 (9.7%) (median progression, 35 months) and 696 patients, respectively. sSHPT was defined as a serum intact parathyroid hormone (PTH) level >800 pg/mL observed three times after active vitamin D pulse therapy. The influence of sSHPT on the prognosis of and risk factors for sSHPT progression were evaluated using logistic and Cox regression analyses. After adjusting for confounding factors, higher (each 100-pg/mL increase) baseline PTH levels (95% confidence interval (CI) 1.206-1.649, p < .001), longer (each 1-year increase) dialysis vintages (95% CI 1.013-1.060, p = .002), higher concomitant diabetes rates (95% CI 1.375-10.374, p = .010), and lower (each 1-absolute unit decrease) Kt/V values (95% CI 0.859-0.984, p = .015) were independent risk factors for progression to sSHPT in patients on PD. During follow-up, 211 deaths occurred (sSHPT group, n = 35; non-sSHPT group, n = 176). The sSHPT group had significantly higher infection-related mortality rates than the non-sSHPT group (12.0% vs. 4.3%; p < .05), and sSHPT was associated with increased infection-related mortality. In conclusion, patients with sSHPT are at higher risk for death and infection-related mortality than patients without sSHPT.
摘要：
继发性甲状旁腺功能亢进（SHPT）可发展为严重的SHPT（sSHPT），影响患者的生存率和生活质量。这项回顾性队列研究调查了771例临床稳定患者（421例男性患者；平均年龄，51.2年；透析年份中位数，28.3个月），在2013年1月至2021年3月期间接受了>3个月的常规腹膜透析（PD）。sSHPT和非sSHPT组包括75（9.7％）（中位进展，35个月）和696名患者，分别。sSHPT定义为在活性维生素D脉冲治疗后3次观察到血清完整甲状旁腺激素(PTH)水平>800pg/mL。使用logistic和Cox回归分析评估sSHPT对sSHPT进展的预后和危险因素的影响。在调整混杂因素后，较高（每增加100pg/mL）基线PTH水平（95％置信区间（CI）1.206-1.649，p<.001），更长的（每增加1年）透析年份（95%CI1.013-1.060，p=.002），合并糖尿病发病率较高（95%CI1.375-10.374，p=.010），较低的Kt/V值（95%CI0.859-0.984，p=0.015）是PD患者进展为sSHPT的独立危险因素。随访期间,发生211例死亡（sSHPT组，n=35；非sSHPT组，n=176）。sSHPT组感染相关死亡率明显高于非sSHPT组（12.0%vs.4.3%；p<0.05)，sSHPT与感染相关死亡率增加相关。总之,与无sSHPT患者相比,有sSHPT患者的死亡和感染相关死亡率风险更高.
