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Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study.
J Am Soc Nephrol. 2005 Jun; 16(6):1788-93.JA

Abstract

Animal studies suggest that calcium-phosphorus homeostatic abnormalities cause cardiovascular disease in uremia; few observational studies in humans have explored this. Associations in the retrospective United States Renal Data System Waves 1, 3, and 4 Study of 14,829 patients who were on hemodialysis on December 31, 1993, were examined. Mean age and duration of renal replacement therapy were 60.0 and 3.2 yr, respectively; 40.7% had diabetes. Quintiles (Q(1) to Q(5)) of (albumin-adjusted) calcium were </=8.7, 8.8 to 9.2, 9.3 to 9.6, 9.7 to 10.2, and >10.2 mg/dl; phosphorus, </=4.4, 4.5 to 5.3, 5.4 to 6.3, 6.4 to 7.5, and >7.5 mg/dl; calcium-phosphorus product, </=40.9, 41.0 to 50.1, 50.2 to 59.2, 59.3 to 71.0, and >71.0 mg(2)/dl(2); and parathyroid hormone (PTH), </=37, 38 to 99, 100 to 210, 211 to 480, and >480 pg/ml. Higher calcium levels were associated with fatal or nonfatal cardiovascular events (adjusted hazards ratio, 1.08 for Q(5), versus Q(1)) and all-cause mortality (Q(2), 1.07; Q(4), 1.11; Q(5), 1.14). Phosphorus levels were associated with cardiovascular events (Q(2), 1.06; Q(3), 1.13; Q(4), 1.14; Q(5), 1.25) and mortality (Q(4), 1.10; Q(5), 1.19), calcium-phosphorus product was associated with cardiovascular events (Q(3), 1.09; Q(4), 1.14; Q(5), 1.24) and mortality (Q(4), 1.09; Q(5), 1.19), and PTH levels were associated with cardiovascular events (Q(5), 1.12) and mortality (Q(5), 1.17). Despite limitations (including retrospective design; noncurrent study era; and lack of serial calcium, phosphorus, and PTH measurements), this study suggests that disorders of calcium homeostasis are associated with fatal and nonfatal cardiovascular events and all-cause mortality in hemodialysis patients.

Authors+Show Affiliations

United States Renal Data System Coordinating Center, 914 South 8th Street, Suite D-253, Minneapolis, MN 55404, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15814832

Citation

Slinin, Yelena, et al. "Calcium, Phosphorus, Parathyroid Hormone, and Cardiovascular Disease in Hemodialysis Patients: the USRDS Waves 1, 3, and 4 Study." Journal of the American Society of Nephrology : JASN, vol. 16, no. 6, 2005, pp. 1788-93.
Slinin Y, Foley RN, Collins AJ. Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005;16(6):1788-93.
Slinin, Y., Foley, R. N., & Collins, A. J. (2005). Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. Journal of the American Society of Nephrology : JASN, 16(6), 1788-93.
Slinin Y, Foley RN, Collins AJ. Calcium, Phosphorus, Parathyroid Hormone, and Cardiovascular Disease in Hemodialysis Patients: the USRDS Waves 1, 3, and 4 Study. J Am Soc Nephrol. 2005;16(6):1788-93. PubMed PMID: 15814832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. AU - Slinin,Yelena, AU - Foley,Robert N, AU - Collins,Allan J, Y1 - 2005/04/06/ PY - 2005/4/9/pubmed PY - 2005/10/22/medline PY - 2005/4/9/entrez SP - 1788 EP - 93 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 16 IS - 6 N2 - Animal studies suggest that calcium-phosphorus homeostatic abnormalities cause cardiovascular disease in uremia; few observational studies in humans have explored this. Associations in the retrospective United States Renal Data System Waves 1, 3, and 4 Study of 14,829 patients who were on hemodialysis on December 31, 1993, were examined. Mean age and duration of renal replacement therapy were 60.0 and 3.2 yr, respectively; 40.7% had diabetes. Quintiles (Q(1) to Q(5)) of (albumin-adjusted) calcium were </=8.7, 8.8 to 9.2, 9.3 to 9.6, 9.7 to 10.2, and >10.2 mg/dl; phosphorus, </=4.4, 4.5 to 5.3, 5.4 to 6.3, 6.4 to 7.5, and >7.5 mg/dl; calcium-phosphorus product, </=40.9, 41.0 to 50.1, 50.2 to 59.2, 59.3 to 71.0, and >71.0 mg(2)/dl(2); and parathyroid hormone (PTH), </=37, 38 to 99, 100 to 210, 211 to 480, and >480 pg/ml. Higher calcium levels were associated with fatal or nonfatal cardiovascular events (adjusted hazards ratio, 1.08 for Q(5), versus Q(1)) and all-cause mortality (Q(2), 1.07; Q(4), 1.11; Q(5), 1.14). Phosphorus levels were associated with cardiovascular events (Q(2), 1.06; Q(3), 1.13; Q(4), 1.14; Q(5), 1.25) and mortality (Q(4), 1.10; Q(5), 1.19), calcium-phosphorus product was associated with cardiovascular events (Q(3), 1.09; Q(4), 1.14; Q(5), 1.24) and mortality (Q(4), 1.09; Q(5), 1.19), and PTH levels were associated with cardiovascular events (Q(5), 1.12) and mortality (Q(5), 1.17). Despite limitations (including retrospective design; noncurrent study era; and lack of serial calcium, phosphorus, and PTH measurements), this study suggests that disorders of calcium homeostasis are associated with fatal and nonfatal cardiovascular events and all-cause mortality in hemodialysis patients. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/15814832/Calcium_phosphorus_parathyroid_hormone_and_cardiovascular_disease_in_hemodialysis_patients:_the_USRDS_waves_1_3_and_4_study_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=15814832 DB - PRIME DP - Unbound Medicine ER -