José L Fernández-Martín1, Adriana Dusso1, Pablo Martínez-Camblor2,3, Maria P Dionisi1, Jürgen Floege4, Markus Ketteler5, Gérard London6, Francesco Locatelli7, José L Górriz8,9, Boleslaw Rutkowski10, Willem-Jan Bos11, Christian Tielemans12, Pierre-Yves Martin13, Rudolf P Wüthrich14, Drasko Pavlovic15, Miha Benedik16, Diego Rodríguez-Puyol17, Juan J Carrero18, Carmine Zoccali19, Jorge B Cannata-Andía1. 1. Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain. 2. Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA. 3. Facultad de Ciencias de la Educación, Universidad Autónoma de Chile, Santiago, Chile. 4. Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany. 5. Division of Nephrology, Klinikum Coburg, Coburg, Germany. 6. Centre Hospitalier FH, Manhes, France. 7. Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy. 8. Department of Nephrology, Hospital Clinico Universitario, Valencia, Spain. 9. Department of Medicine, Health Research Institute INCLIVA, University of Valencia, Valencia, Spain. 10. Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland. 11. Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. 12. Department of Nephrology, UZ Brussel, Brussels, Belgium. 13. Nephrology Division, Geneva University Hospital, Geneva, Switzerland. 14. Division of Nephrology, University Hospital, Zürich, Switzerland. 15. Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia. 16. Department of Nephrology, University Medical Centre, Ljubljana, Slovenia. 17. Department of Medicine, Universidad de Alcalá Nephrology Section and Research Unit Foundation, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain IRSIN REDinREN (Instituto de Salud Carlos III), Madrid, Spain. 18. Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Sweden. 19. CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Italy.
Abstract
BACKGROUND: Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. METHODS: The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. RESULTS: There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). CONCLUSION: Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.
BACKGROUND: Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. METHODS: The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. RESULTS: There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). CONCLUSION: Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.
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
Authors: Xiaoling Ye; Jeroen P Kooman; Frank M van der Sande; Jochen G Raimann; Len A Usvyat; Yuedong Wang; Franklin W Maddux; Peter Kotanko Journal: Clin Kidney J Date: 2019-12-05
Authors: Marc G Vervloet; Ioannis N Boletis; Angel L M de Francisco; Philip A Kalra; Markus Ketteler; Piergiorgio Messa; Manuela Stauss-Grabo; Anja Derlet; Sebastian Walpen; Amandine Perrin; Linda H Ficociello; Jacques Rottembourg; Christoph Wanner; Jorge B Cannata-Andía; Denis Fouque Journal: Clin Kidney J Date: 2021-02-05
Authors: Emilio Sánchez-Álvarez; Minerva Rodríguez-García; Francesco Locatelli; Carmine Zoccali; Alejandro Martín-Malo; Jürgen Floege; Markus Ketteler; Gerard London; José L Górriz; Boleslaw Rutkowski; Anibal Ferreira; Drasko Pavlovic; Jorge B Cannata-Andía; José L Fernández-Martín Journal: Clin Kidney J Date: 2020-12-26