Claudia Lamina1, Florian Kronenberg1, Peter Stenvinkel2, Marc Froissart3, Lukas Forer1, Sebastian Schönherr1, David C Wheeler4, Kai-Uwe Eckardt5, Jürgen Floege6. 1. Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria. 2. Department of Renal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden. 3. Centre Hospitalier Universitaire Vaudois, Clinical Trial Unit, Lausanne, Switzerland. 4. Center for Nephrology, University College London, London, UK. 5. Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Germany. 6. Department of Nephrology, Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany.
Abstract
BACKGROUND: There is little information in haemodialysis (HD) patients on whether temporal changes in serum calcium, phosphate or intact parathyroid hormone (iPTH) are associated with mortality. METHODS: We analysed associations of phosphate, total calcium and iPTH with all-cause and cardiovascular mortality in 8817 incident HD patients from the European second Analyzing Data, Recognizing Excellence and Optimizing Outcomes (AROii) cohort enrolled in 2007-09, which were prospectively followed for a median of 3 years, using time-dependent Cox proportional hazards models. We evaluated changes in risk over time depending on changes in phosphate, calcium or iPTH. RESULTS: The association of phosphate and iPTH with all-cause mortality was U-shaped, with the lowest risk ranges between 1.20 and 1.89 mmol/L for phosphate and between 239 and 710 ng/L for iPTH. For total calcium, the associations were J-shaped, with an increased risk for all-cause mortality at levels >2.36 mmol/L. Lowest risk ranges for cardiovascular mortality did not change markedly for all three parameters. If iPTH was below the lowest risk range at baseline (iPTH <239 ng/L), a subsequent increase in levels was associated with improved survival. For phosphate, an increase or decrease out of the lowest risk range was associated with increased mortality risk. For calcium, this was only the case when the values increased above the lowest risk range. CONCLUSION: In the AROii cohort, the ranges of bone mineral biomarkers associated with the lowest mortality ranges were largely consistent with the current Kidney Disease: Improving Global Outcomes chronic kidney disease-mineral and bone disorder guideline recommendations. Allowing a suppressed iPTH to increase was associated with a lower mortality, whereas shifts of phosphate or calcium outside the lowest risk range increased mortality.
BACKGROUND: There is little information in haemodialysis (HD) patients on whether temporal changes in serum calcium, phosphate or intact parathyroid hormone (iPTH) are associated with mortality. METHODS: We analysed associations of phosphate, total calcium and iPTH with all-cause and cardiovascular mortality in 8817 incident HDpatients from the European second Analyzing Data, Recognizing Excellence and Optimizing Outcomes (AROii) cohort enrolled in 2007-09, which were prospectively followed for a median of 3 years, using time-dependent Cox proportional hazards models. We evaluated changes in risk over time depending on changes in phosphate, calcium or iPTH. RESULTS: The association of phosphate and iPTH with all-cause mortality was U-shaped, with the lowest risk ranges between 1.20 and 1.89 mmol/L for phosphate and between 239 and 710 ng/L for iPTH. For total calcium, the associations were J-shaped, with an increased risk for all-cause mortality at levels >2.36 mmol/L. Lowest risk ranges for cardiovascular mortality did not change markedly for all three parameters. If iPTH was below the lowest risk range at baseline (iPTH <239 ng/L), a subsequent increase in levels was associated with improved survival. For phosphate, an increase or decrease out of the lowest risk range was associated with increased mortality risk. For calcium, this was only the case when the values increased above the lowest risk range. CONCLUSION: In the AROii cohort, the ranges of bone mineral biomarkers associated with the lowest mortality ranges were largely consistent with the current Kidney Disease: Improving Global Outcomes chronic kidney disease-mineral and bone disorder guideline recommendations. Allowing a suppressed iPTH to increase was associated with a lower mortality, whereas shifts of phosphate or calcium outside the lowest risk range increased mortality.
Authors: Pablo Molina; Mariola D Molina; Luis M Pallardó; Javier Torralba; Verónica Escudero; Luis Álvarez; Ana Peris; Pilar Sánchez-Pérez; Miguel González-Rico; María J Puchades; José E Fernández-Nájera; Elena Giménez-Civera; Luis D'Marco; Juan J Carrero; José L Górriz Journal: J Nephrol Date: 2021-01-04 Impact factor: 3.902
Authors: Ursula Thiem; Ina Soellradl; Bernhard Robl; Ewa Watorek; Sabine Blum; Alexandra Dumfarth; Rodrig Marculescu; Andreas Pasch; Maria C Haller; Daniel Cejka Journal: Clin Kidney J Date: 2020-10-28
Authors: Jordi Bover; Armando Aguilar; Carolt Arana; Pablo Molina; María Jesús Lloret; Jackson Ochoa; Gerson Berná; Yessica G Gutiérrez-Maza; Natacha Rodrigues; Luis D'Marco; José L Górriz Journal: Front Med (Lausanne) Date: 2021-05-19