期刊
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
卷 13, 期 12, 页码 1816-1824出版社
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.05390518
关键词
Hypertension; parathyroid hormone; mineral metabolism; cardiovascular disease; congestive heart failure
资金
- National Institutes of Health (NIH)
- National Research Service Award through the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) [RO1DK098234, K24DK110427, T32DK104717, F32DK116476]
- NIH Loan Repayment Program
- American Society of Nephrology Ben J. Lipps Research Fellowship Program
- American Heart Association [14EIA18560026]
- NIH
- National Heart, Lung, and Blood Institute
- NIDDK
- National Institute on Aging
- National Institute of Neurological Disorders and Stroke [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, A-H-13-002-001]
- National Center for Advancing Translational Sciences: Case Western Reserve University [UL1TR000439]
- Ohio State University [UL1RR025755]
- University of Pennsylvania [UL1RR024134, UL1TR000003]
- Boston University [UL1RR025771]
- Stanford University [UL1TR000093]
- Tufts University [UL1RR025752, UL1TR000073, UL1TR001064]
- University of Illinois [UL1TR000050]
- University of Pittsburgh [UL1TR000005]
- University of Texas, Southwestern [9U54TR000017-06]
- University of Utah [UL1TR000105-05]
- Vanderbilt University [UL1 TR000445]
- George Washington University [UL1TR000075]
- University of CA, Davis [UL1 TR000002]
- University of Florida [UL1 TR000064]
- University of Michigan [UL1TR000433]
- Tulane University: Centers of Biomedical Research Excellence Award National Institute of General Medical Sciences [P30GM103337]
- Wake Forest University [UL1TR001420]
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR001064, UL1TR002548, UL1TR000445, UL1TR002240, UL1TR000439, UL1TR000433, UL1TR001420, UL1TR001427, UL1TR002003] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [T32DK104717, R01DK098234, F32DK116476, K24DK110427] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES [P30GM103337] Funding Source: NIH RePORTER
Background and objectives The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive BP lowering reduced the risk of cardiovascular disease, but increased eGFR decline. Serum parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) concentrations are elevated in CKD and are associated with cardiovascular disease. We evaluated whether intact PTH or intact FGF23 concentrations modify the effects of intensive BP control on cardiovascular events, heart failure, and all-cause mortality in SPRINT participants with CKD. Design, setting, participants, & measurements We measured PTH and FGF23 in 2486 SPRINT participants with eGFR<60 ml/min per 1.73 m(2) at baseline. Cox models were used to evaluate whether serum PTH and FGF23 concentrations were associated with cardiovascular events, heart failure, and all-cause mortality, and whether PTH and FGF23 modified the effects of intensive BP control. Results The mean age of this subcohort was 73 years, 60% were men, and mean eGFR was 4611 ml/min per 1.73 m(2). Median PTH was 48 (interquartile range [IQR], 35-67) pg/ml and FGF23 was 66 (IQR, 52-88) pg/ml. There were 261 composite cardiovascular events, 102 heart failure events, and 179 deaths within the subcohort. The adjusted hazard ratio (HR) per doubling of PTH concentration for cardiovascular events, heart failure, and all-cause mortality were 1.29 (95% confidence interval [95% CI], 1.06 to 1.57), 1.32 (95% CI, 0.96 to 1.83), and 1.04 (95% CI, 0.82 to 1.31), respectively. There were significant interactions between PTH and BP arm for both the cardiovascular (P-interaction=0.01) and heart failure (P-interaction=0.004) end points. Participants with a PTH above the median experienced attenuated benefits of intensive BP control on cardiovascular events (adjusted HR, 1.02; 95% CI, 0.72 to 1.42) compared with participants with a PTH below the median (adjusted HR, 0.67; 95% CI, 0.45 to 1.00). FGF23 was not independently associated with any outcome and did not modify the effects of the intervention. Conclusions SPRINT participants with CKD and a high serum PTH received less cardiovascular protection from intensive BP therapy than participants with a lower serum PTH.
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