BACKGROUND: The K/DOQI guideline for bone metabolism and disease in chronic kidney disease is predominantly based on studies in haemodialysis (HD) patients. However, in clinical practice, this guideline is also applied to peritoneal dialysis (PD) patients. To validate the implementation of this guideline in PD patients, we evaluated the associations between plasma concentrations outside the K/DOQI-targets and the risk of cardiovascular morbidity and mortality in incident PD patients compared with HD patients. METHODS: In a large prospective multicentre study in the Netherlands (The Netherlands Cooperative Study on the Adequacy of Dialysis, NECOSAD), we included patients starting PD or HD between 1997 and 2004. Relative risk of cardiovascular morbidity and mortality were estimated using time-dependent Cox regression modelling. RESULTS: We included 586 PD patients with mean age 52 +/- 15 years (66% males) and 1043 HD patients with mean age 63 +/- 14 years (58% males). Cardiovascular disease (CVD) was the reason for hospitalization in 102 PD and 271 HD patients. In HD patients, the relative risk of CVD-related hospitalization increased with elevated plasma calcium concentrations (hazard ratio: 1.4; 95% CI: 1.1-1.9). Cardiovascular mortality was significantly higher for phosphorus concentrations above the K/DOQI-threshold in PD (2.4; 95% CI: 1.3-4.2) and HD patients (1.5; 95% CI: 1.1-2.1), and for elevated Ca x P in PD (2.2; 95% CI: 1.3-3.8) and HD patients (1.5; 95% CI: 1.1-2.1). CONCLUSIONS: Plasma calcium concentrations above the K/DOQI-threshold increase the relative risk of CVD-related hospitalization in HD patients. Associations with cardiovascular mortality were more pronounced. Both in PD and HD patients with elevated plasma phosphorus and Ca x P concentrations, the cardiovascular mortality risk is increased. Therefore, it seems appropriate to adopt the current guideline in PD patients.
BACKGROUND: The K/DOQI guideline for bone metabolism and disease in chronic kidney disease is predominantly based on studies in haemodialysis (HD) patients. However, in clinical practice, this guideline is also applied to peritoneal dialysis (PD) patients. To validate the implementation of this guideline in PDpatients, we evaluated the associations between plasma concentrations outside the K/DOQI-targets and the risk of cardiovascular morbidity and mortality in incident PDpatients compared with HDpatients. METHODS: In a large prospective multicentre study in the Netherlands (The Netherlands Cooperative Study on the Adequacy of Dialysis, NECOSAD), we included patients starting PD or HD between 1997 and 2004. Relative risk of cardiovascular morbidity and mortality were estimated using time-dependent Cox regression modelling. RESULTS: We included 586 PDpatients with mean age 52 +/- 15 years (66% males) and 1043 HDpatients with mean age 63 +/- 14 years (58% males). Cardiovascular disease (CVD) was the reason for hospitalization in 102 PD and 271 HDpatients. In HDpatients, the relative risk of CVD-related hospitalization increased with elevated plasma calcium concentrations (hazard ratio: 1.4; 95% CI: 1.1-1.9). Cardiovascular mortality was significantly higher for phosphorus concentrations above the K/DOQI-threshold in PD (2.4; 95% CI: 1.3-4.2) and HDpatients (1.5; 95% CI: 1.1-2.1), and for elevated Ca x P in PD (2.2; 95% CI: 1.3-3.8) and HDpatients (1.5; 95% CI: 1.1-2.1). CONCLUSIONS: Plasma calcium concentrations above the K/DOQI-threshold increase the relative risk of CVD-related hospitalization in HDpatients. Associations with cardiovascular mortality were more pronounced. Both in PD and HDpatients with elevated plasma phosphorus and Ca x P concentrations, the cardiovascular mortality risk is increased. Therefore, it seems appropriate to adopt the current guideline in PDpatients.
Authors: Thijs T Jansz; Franka E van Reekum; Akin Özyilmaz; Pim A de Jong; Franciscus T J Boereboom; Tiny Hoekstra; Marianne C Verhaar; Brigit C van Jaarsveld Journal: Am J Nephrol Date: 2018-11-13 Impact factor: 3.754
Authors: Cláudia Ribeiro; Maria Goretti Moreira Guimarães Penido; Milena Maria Moreira Guimarães; Marcelo de Sousa Tavares; Bruno das Neves Souza; Anderson Ferreira Leite; Leonardo Martins Caldeira de Deus; Lucas José de Campos Machado Journal: World J Nephrol Date: 2016-09-06
Authors: Sunil V Badve; Deborah L Zimmerman; Greg A Knoll; Kevin D Burns; Brendan B McCormick Journal: Clin J Am Soc Nephrol Date: 2008-09-24 Impact factor: 8.237
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