Mengjing Wang1,2, Yoshitsugu Obi1, Elani Streja1, Connie M Rhee1, Wei Ling Lau1, Jing Chen2, Chuanming Hao2, Takayuki Hamano3, Csaba P Kovesdy4,5, Kamyar Kalantar-Zadeh6,7,8. 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California. 2. Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China. 3. Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Osaka, Japan. 4. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee. 5. Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. 6. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California; kkz@uci.edu. 7. Department of Epidemiology, Fielding School of Public Health at University of California, Los Angeles, Los Angeles, California; and. 8. Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California.
Abstract
BACKGROUND AND OBJECTIVES: The relationship between mineral and bone disorders and survival according to residual kidney function status has not been previously studied in patients on hemodialysis. We hypothesized that residual kidney function, defined by renal urea clearance, modifies the association between mineral and bone disorder parameters and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The associations of serum phosphorus, albumin-corrected calcium, intact parathyroid hormone, and alkaline phosphatase with all-cause mortality were examined across three strata (<1.5, 1.5 to <3.0, and ≥3.0 ml/min per 1.73 m2) of baseline residual renal urea clearance using Cox models adjusted for clinical characteristics and laboratory measurements in 35,114 incident hemodialysis patients from a large United States dialysis organization over the period of 2007-2011. RESULTS: A total of 8102 (23%) patients died during the median follow-up of 1.3 years (interquartile range, 0.6-2.3 years). There was an incremental mortality risk across higher serum phosphorus concentrations, which was pronounced among patients with higher residual renal urea clearance (Pinteraction=0.001). Lower concentrations of serum intact parathyroid hormone were associated with higher mortality among patients with low residual renal urea clearance (i.e., <1.5 ml/min per 1.73 m2), whereas higher concentrations showed a higher mortality risk among patients with greater residual renal urea clearance (i.e., ≥1.5 ml/min per 1.73 m2; Pinteraction<0.001). Higher serum corrected total calcium and higher alkaline phosphatase concentrations consistently showed higher mortality risk (Ptrend<0.001 for both) irrespective of residual renal urea clearance strata (Pinteraction=0.34 and Pinteraction=0.53, respectively). CONCLUSIONS: Residual kidney function modified the mortality risk associated with serum phosphorus and intact parathyroid hormone among incident hemodialysis patients. Future studies are needed to examine whether taking account for residual kidney function into the assessment of mortality risk associated with serum phosphorus and intact parathyroid hormone improves patient management and clinical outcomes in the hemodialysis population.
BACKGROUND AND OBJECTIVES: The relationship between mineral and bone disorders and survival according to residual kidney function status has not been previously studied in patients on hemodialysis. We hypothesized that residual kidney function, defined by renal urea clearance, modifies the association between mineral and bone disorder parameters and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The associations of serum phosphorus, albumin-corrected calcium, intact parathyroid hormone, and alkaline phosphatase with all-cause mortality were examined across three strata (<1.5, 1.5 to <3.0, and ≥3.0 ml/min per 1.73 m2) of baseline residual renal urea clearance using Cox models adjusted for clinical characteristics and laboratory measurements in 35,114 incident hemodialysis patients from a large United States dialysis organization over the period of 2007-2011. RESULTS: A total of 8102 (23%) patients died during the median follow-up of 1.3 years (interquartile range, 0.6-2.3 years). There was an incremental mortality risk across higher serum phosphorus concentrations, which was pronounced among patients with higher residual renal urea clearance (Pinteraction=0.001). Lower concentrations of serum intact parathyroid hormone were associated with higher mortality among patients with low residual renal urea clearance (i.e., <1.5 ml/min per 1.73 m2), whereas higher concentrations showed a higher mortality risk among patients with greater residual renal urea clearance (i.e., ≥1.5 ml/min per 1.73 m2; Pinteraction<0.001). Higher serum corrected total calcium and higher alkaline phosphatase concentrations consistently showed higher mortality risk (Ptrend<0.001 for both) irrespective of residual renal urea clearance strata (Pinteraction=0.34 and Pinteraction=0.53, respectively). CONCLUSIONS: Residual kidney function modified the mortality risk associated with serum phosphorus and intact parathyroid hormone among incident hemodialysis patients. Future studies are needed to examine whether taking account for residual kidney function into the assessment of mortality risk associated with serum phosphorus and intact parathyroid hormone improves patient management and clinical outcomes in the hemodialysis population.
Authors: Glenn M Chertow; Nathan W Levin; Gerald J Beck; John T Daugirdas; Paul W Eggers; Alan S Kliger; Brett Larive; Michael V Rocco; Tom Greene Journal: J Am Soc Nephrol Date: 2015-10-14 Impact factor: 10.121
Authors: E Lars Penne; Neelke C van der Weerd; Muriel P C Grooteman; Albert H A Mazairac; Marinus A van den Dorpel; Menso J Nubé; Michiel L Bots; Renée Lévesque; Piet M ter Wee; Peter J Blankestijn Journal: Clin J Am Soc Nephrol Date: 2010-10-28 Impact factor: 8.237
Authors: Deborah L Regidor; Csaba P Kovesdy; Rajnish Mehrotra; Mehdi Rambod; Jennie Jing; Charles J McAllister; David Van Wyck; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: J Am Soc Nephrol Date: 2008-07-30 Impact factor: 10.121
Authors: Melissa Soohoo; Yoshitsugu Obi; Matthew B Rivara; Scott V Adams; Wei Ling Lau; Connie M Rhee; Csaba P Kovesdy; Kamyar Kalantar-Zadeh; Onyebuchi A Arah; Rajnish Mehrotra; Elani Streja Journal: Am J Nephrol Date: 2022-02-28 Impact factor: 4.605