Abstract

Background

Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes.

Methods

We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association.

Results

We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days.

Conclusions

Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

中文翻译：

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肾移植后的钙和磷酸盐水平以及患者和同种异体移植物的长期存活率

摘要

背景

非传统心血管危险因素，包括钙和磷酸盐紊乱，可能在肾移植死亡率中起作用。关于这种影响的数据是相互矛盾的。我们的目的是评估移植后前 90 天内钙和磷酸盐紊乱对同种异体移植物和受体结果的影响。

方法

我们对 1999 年至 2015 年间在爱尔兰共和国进行的全成人首次肾移植进行了回顾性队列研究。我们根据移植后的血清磷酸盐和钙水平将患者分为三组。我们评估了它们对死亡审查移植物存活率和全因死亡率的影响。我们使用Stata进行统计分析，并进行生存分析和样条曲线来评估关联。

结果

我们纳入了 1525 名肾移植受者。其中，86.3% 患有低磷血症，36.1% 患有高钙血症。与其他三分位数相比，处于最低磷酸盐三分位数的患者更年轻，更有可能是女性，体重较轻，透析时间更长，接受了年轻供体的肾脏，移植功能延迟较少，移植功能更好。钙含量最高的患者更年轻，更可能是男性，体重指数更高，透析时间更长，移植功能更好。调整组间差异后，我们无法显示死亡审查移植失败的任何差异 [磷酸盐 = 1.14, 95% 置信区间 (CI) 0.92–1.41; 钙 = 0.98, 95% CI 0.80–1.20] 或全因死亡率（磷酸盐 = 1.10, 95% CI 0.91–1.32；钙 = 0.96, 95% CI 0.81–1。

结论

低磷血症和高钙血症是肾移植后常见的情况。我们已经确定了这些代谢紊乱的不同风险因素。钙和磷酸盐水平与死亡审查移植失败和死亡率没有独立关联。