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Calcium, phosphorus, cardiovascular events and all-cause mortality in hemodialysis patients: a single-center retrospective cohort study to reassess the validity of the Japanese Society for Dialysis Therapy guidelines.
Ther Apher Dial. 2008 Feb; 12(1):42-8.TA

Abstract

Mineral and bone disorders frequently cause cardiovascular complications and mortality in hemodialysis patients, but few observational studies of Japanese patients have investigated this matter. A retrospective cohort study of 99 patients (53 males, 46 females; mean age: 65 +/- 12 year; 38% with diabetes mellitus) on maintenance hemodialysis in our dialysis center was conducted. Mean serum Ca, P and intact parathyroid hormone (iPTH) levels were 9.2 +/- 0.9 mg/dL, 6.1 +/- 1.7 mg/dL, and 233 +/- 333 pg/mL, respectively. The cutoff values for each of these three parameter were defined according to the target ranges recommended by the Japanese Society for Dialysis Therapy (JSDT) guidelines (Ca: 8.4-10.0 mg/dL; P: 3.5-6.0 mg/dL; iPTH: 60-180 pg/mL). During a 45-month follow up, patients with all parameters outside the target ranges showed the highest incidence of cardiovascular events and all-cause deaths (16.6 and 29.2 per 1000 person-years, respectively). The relative risks of cardiovascular events and all-cause deaths were analyzed by multivariate Cox regression models. The hazard ratio (HR) for cardiovascular events was significantly lower for patients who achieved serum Ca and P objectives compared with others (HR: 2.12; 95% CI: 1.04-4.34; P < 0.05), and similar differences were observed for all-cause deaths (HR: 3.10; 95% CI: 1.13-8.53; P < 0.05). However, the relationship between iPTH levels and each of the endpoints was less pronounced. The results of this study provide support for the JSDT guidelines, which give priority to the control of serum Ca and P levels over the control of parathyroid function.

Authors+Show Affiliations

Department of Internal Medicine, Takasago Municipal Hospital, Takasago, Japan. hkomaba@med.kobe-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

18257811

Citation

Komaba, Hirotaka, et al. "Calcium, Phosphorus, Cardiovascular Events and All-cause Mortality in Hemodialysis Patients: a Single-center Retrospective Cohort Study to Reassess the Validity of the Japanese Society for Dialysis Therapy Guidelines." Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, vol. 12, no. 1, 2008, pp. 42-8.
Komaba H, Igaki N, Takashima M, et al. Calcium, phosphorus, cardiovascular events and all-cause mortality in hemodialysis patients: a single-center retrospective cohort study to reassess the validity of the Japanese Society for Dialysis Therapy guidelines. Ther Apher Dial. 2008;12(1):42-8.
Komaba, H., Igaki, N., Takashima, M., Goto, S., Yokota, K., Komada, H., Takemoto, T., Kohno, M., Kadoguchi, H., Hirosue, Y., & Goto, T. (2008). Calcium, phosphorus, cardiovascular events and all-cause mortality in hemodialysis patients: a single-center retrospective cohort study to reassess the validity of the Japanese Society for Dialysis Therapy guidelines. Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 12(1), 42-8. https://doi.org/10.1111/j.1744-9987.2007.00539.x
Komaba H, et al. Calcium, Phosphorus, Cardiovascular Events and All-cause Mortality in Hemodialysis Patients: a Single-center Retrospective Cohort Study to Reassess the Validity of the Japanese Society for Dialysis Therapy Guidelines. Ther Apher Dial. 2008;12(1):42-8. PubMed PMID: 18257811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcium, phosphorus, cardiovascular events and all-cause mortality in hemodialysis patients: a single-center retrospective cohort study to reassess the validity of the Japanese Society for Dialysis Therapy guidelines. AU - Komaba,Hirotaka, AU - Igaki,Naoya, AU - Takashima,Mototsugu, AU - Goto,Shunsuke, AU - Yokota,Kazuki, AU - Komada,Hisako, AU - Takemoto,Toshiyuki, AU - Kohno,Maki, AU - Kadoguchi,Hiraku, AU - Hirosue,Yoshiaki, AU - Goto,Takeo, PY - 2008/2/9/pubmed PY - 2008/4/23/medline PY - 2008/2/9/entrez SP - 42 EP - 8 JF - Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy JO - Ther Apher Dial VL - 12 IS - 1 N2 - Mineral and bone disorders frequently cause cardiovascular complications and mortality in hemodialysis patients, but few observational studies of Japanese patients have investigated this matter. A retrospective cohort study of 99 patients (53 males, 46 females; mean age: 65 +/- 12 year; 38% with diabetes mellitus) on maintenance hemodialysis in our dialysis center was conducted. Mean serum Ca, P and intact parathyroid hormone (iPTH) levels were 9.2 +/- 0.9 mg/dL, 6.1 +/- 1.7 mg/dL, and 233 +/- 333 pg/mL, respectively. The cutoff values for each of these three parameter were defined according to the target ranges recommended by the Japanese Society for Dialysis Therapy (JSDT) guidelines (Ca: 8.4-10.0 mg/dL; P: 3.5-6.0 mg/dL; iPTH: 60-180 pg/mL). During a 45-month follow up, patients with all parameters outside the target ranges showed the highest incidence of cardiovascular events and all-cause deaths (16.6 and 29.2 per 1000 person-years, respectively). The relative risks of cardiovascular events and all-cause deaths were analyzed by multivariate Cox regression models. The hazard ratio (HR) for cardiovascular events was significantly lower for patients who achieved serum Ca and P objectives compared with others (HR: 2.12; 95% CI: 1.04-4.34; P < 0.05), and similar differences were observed for all-cause deaths (HR: 3.10; 95% CI: 1.13-8.53; P < 0.05). However, the relationship between iPTH levels and each of the endpoints was less pronounced. The results of this study provide support for the JSDT guidelines, which give priority to the control of serum Ca and P levels over the control of parathyroid function. SN - 1744-9987 UR - https://www.unboundmedicine.com/medline/citation/18257811/Calcium_phosphorus_cardiovascular_events_and_all_cause_mortality_in_hemodialysis_patients:_a_single_center_retrospective_cohort_study_to_reassess_the_validity_of_the_Japanese_Society_for_Dialysis_Therapy_guidelines_ L2 - https://doi.org/10.1111/j.1744-9987.2007.00539.x DB - PRIME DP - Unbound Medicine ER -