基于美国国家健康与营养检查调查数据库(1999-2018年)的成年慢性肾脏病患者高磷血症患病率分析

Prevalence of hyperphosphatemia in adult patients with chronic kidney disease based on the 1999-2018 National Health and Nutrition Examination Survey of USA

目的统计美国成年慢性肾脏病(CKD)患者高磷血症的患病率,分析CKD患者临床特征与高磷血症的关联。方法基于美国国家健康与营养检查调查(NHANES)数据库1999-2018年的数据,统计描述不同年份、不同CKD分期成年CKD患者高磷血症患病率。使用多因素logistic回归模型分析CKD患者临床特征与高磷血症的关联。结果共9311例CKD 1~5期的成年患者纳入分析,高磷血症的加权患病率为9.8%。1999-2004年间,高磷血症的加权患病率随着时间的推移呈增长趋势,此后至2012年保持相对稳定,2013-2014年加权患病率最高,此后随着时间的推移逐渐下降。高磷血症的加权患病率随着CKD分期的进展而增加,1~2期、3a期、3b期、4期、5期CKD患者分别为7.99%、8.64%、11.90%、21.57%、54.66%。CKD患者中男性(OR=0.53)、老年人(65~74岁者OR=0.67,≥75岁者OR=0.53)、肥胖者(BMI≥30 kg/m2,OR=0.79)的高磷血症患病率较低(P均<0.05)。结论CKD患者在肾功能受损的早期(CKD 3a期)高磷血症患病率即升高,男性、老年人、肥胖者倾向于较低的高磷血症患病率。

Objective To investigate the prevalence of hyperphosphatemia in adult patients with chronic kidney disease(CKD)in the United States,and to analyze the association between clinical features of CKD patients and hyperphosphatemia.Methods Based on the National Health and Nutrition Examination Survey(NHANES)data from 1999 to 2018,the prevalence of hyperphosphatemia in adult patients with CKD stratified by survey years and CKD stages was statistically described.Multivariate logistic regression was used to analyze the association between clinical features of CKD patients and hyperphosphatemia.Results Totally 9311 adult patients with CKD staged 1-5 were included.The weighted prevalence of hyperphosphatemia was 9.8%.From 1999 to 2004,the weighted prevalence of hyperphosphatemia showed an increasing trend over time,and remained relatively stable from then on to 2012.The weighted prevalence was the highest from 2013 to 2014,and then gradually decreased over time.The weighted prevalence of hyperphosphatemia increased with the progression of CKD stages,which were 7.99%,8.64%,11.90%,21.57%,and 54.66% in the patients with CKD stages 1-2,3a,3b,4,and 5,respectively.Men(odds ratio[OR]=0.53),the elder(OR=0.67 for those 65-74 years old and 0.53 for≥75 years old),and patients with obesity(body mass index≥30 kg/m2,OR=0.79)tended to have a lower prevalence of hyperphosphatemia(all P<0.05).Conclusion The prevalence of hyperphosphatemia in CKD patients is increased at the early stage of renal impairment(i.e.,CKD 3a).Male,elderly and obese CKD patients tend to have a lower prevalence of hyperphosphatemia.