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Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS).
Am J Kidney Dis. 2008 Sep; 52(3):519-30.AJ

Abstract

BACKGROUND

Abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) concentrations are common in patients with chronic kidney disease and have been associated with increased morbidity and mortality. No clinical trials have been conducted to clearly identify categories of calcium, phosphorus, and PTH levels associated with the lowest mortality risk. Current clinical practice guidelines are based largely on expert opinions, and clinically relevant differences exist among guidelines across countries. We sought to describe international trends in calcium, phosphorus, and PTH levels during 10 years and identify mortality risk categories in the Dialysis Outcomes and Practice Patterns Study (DOPPS), an international study of hemodialysis practices and associated outcomes.

STUDY DESIGN

Prospective cohort study.

PARTICIPANTS

25,588 patients with end-stage renal disease on hemodialysis therapy for longer than 180 days at 925 facilities in DOPPS I (1996-2001), DOPPS II (2002-2004), or DOPPS III (2005-2007).

PREDICTORS

Serum calcium, albumin-corrected calcium (Ca(Alb)), phosphorus, and PTH levels.

OUTCOMES

Adjusted hazard ratios for all-cause and cardiovascular mortality calculated using Cox models.

RESULTS

Distributions of mineral metabolism markers differed across DOPPS countries and phases, with lower calcium and phosphorus levels observed in the most recent phase of DOPPS. Survival models identified categories with the lowest mortality risk for calcium (8.6 to 10.0 mg/dL), Ca(Alb) (7.6 to 9.5 mg/dL), phosphorus (3.6 to 5.0 mg/dL), and PTH (101 to 300 pg/mL). The greatest risk of mortality was found for calcium or Ca(Alb) levels greater than 10.0 mg/dL, phosphorus levels greater than 7.0 mg/dL, and PTH levels greater than 600 pg/mL and in patients with combinations of high-risk categories of calcium, phosphorus, and PTH.

LIMITATIONS

Because of the observational nature of DOPPS, this study can only indicate an association between mineral metabolism categories and mortality.

CONCLUSIONS

Our results provide important information about mineral metabolism trends in hemodialysis patients in 12 countries during a decade. The risk categories identified in the DOPPS cohort may be relevant to efforts at international harmonization of existing clinical guidelines for mineral metabolism.

Authors+Show Affiliations

Arbor Research Collaborative for Health, University of Michigan, Ann Arbor, MI 48103, USA. francesca.tentori@ArborResearch.orgNo 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 availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18514987

Citation

Tentori, Francesca, et al. "Mortality Risk for Dialysis Patients With Different Levels of Serum Calcium, Phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS)." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 52, no. 3, 2008, pp. 519-30.
Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008;52(3):519-30.
Tentori, F., Blayney, M. J., Albert, J. M., Gillespie, B. W., Kerr, P. G., Bommer, J., Young, E. W., Akizawa, T., Akiba, T., Pisoni, R. L., Robinson, B. M., & Port, F. K. (2008). Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 52(3), 519-30. https://doi.org/10.1053/j.ajkd.2008.03.020
Tentori F, et al. Mortality Risk for Dialysis Patients With Different Levels of Serum Calcium, Phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008;52(3):519-30. PubMed PMID: 18514987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). AU - Tentori,Francesca, AU - Blayney,Margaret J, AU - Albert,Justin M, AU - Gillespie,Brenda W, AU - Kerr,Peter G, AU - Bommer,Jürgen, AU - Young,Eric W, AU - Akizawa,Tadao, AU - Akiba,Takashi, AU - Pisoni,Ronald L, AU - Robinson,Bruce M, AU - Port,Friedrich K, Y1 - 2008/06/02/ PY - 2007/10/16/received PY - 2008/03/24/accepted PY - 2008/6/3/pubmed PY - 2008/9/19/medline PY - 2008/6/3/entrez SP - 519 EP - 30 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 52 IS - 3 N2 - BACKGROUND: Abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) concentrations are common in patients with chronic kidney disease and have been associated with increased morbidity and mortality. No clinical trials have been conducted to clearly identify categories of calcium, phosphorus, and PTH levels associated with the lowest mortality risk. Current clinical practice guidelines are based largely on expert opinions, and clinically relevant differences exist among guidelines across countries. We sought to describe international trends in calcium, phosphorus, and PTH levels during 10 years and identify mortality risk categories in the Dialysis Outcomes and Practice Patterns Study (DOPPS), an international study of hemodialysis practices and associated outcomes. STUDY DESIGN: Prospective cohort study. PARTICIPANTS: 25,588 patients with end-stage renal disease on hemodialysis therapy for longer than 180 days at 925 facilities in DOPPS I (1996-2001), DOPPS II (2002-2004), or DOPPS III (2005-2007). PREDICTORS: Serum calcium, albumin-corrected calcium (Ca(Alb)), phosphorus, and PTH levels. OUTCOMES: Adjusted hazard ratios for all-cause and cardiovascular mortality calculated using Cox models. RESULTS: Distributions of mineral metabolism markers differed across DOPPS countries and phases, with lower calcium and phosphorus levels observed in the most recent phase of DOPPS. Survival models identified categories with the lowest mortality risk for calcium (8.6 to 10.0 mg/dL), Ca(Alb) (7.6 to 9.5 mg/dL), phosphorus (3.6 to 5.0 mg/dL), and PTH (101 to 300 pg/mL). The greatest risk of mortality was found for calcium or Ca(Alb) levels greater than 10.0 mg/dL, phosphorus levels greater than 7.0 mg/dL, and PTH levels greater than 600 pg/mL and in patients with combinations of high-risk categories of calcium, phosphorus, and PTH. LIMITATIONS: Because of the observational nature of DOPPS, this study can only indicate an association between mineral metabolism categories and mortality. CONCLUSIONS: Our results provide important information about mineral metabolism trends in hemodialysis patients in 12 countries during a decade. The risk categories identified in the DOPPS cohort may be relevant to efforts at international harmonization of existing clinical guidelines for mineral metabolism. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18514987/Mortality_risk_for_dialysis_patients_with_different_levels_of_serum_calcium_phosphorus_and_PTH:_the_Dialysis_Outcomes_and_Practice_Patterns_Study__DOPPS__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)00653-7 DB - PRIME DP - Unbound Medicine ER -