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Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population.
Nephrol Dial Transplant. 2011 Jun; 26(6):1948-55.ND

Abstract

BACKGROUND

A number of US observational studies reported an increased mortality risk with higher intact parathyroid hormone (iPTH), calcium and/or phosphate. The existence of such a link in a European haemodialysis population was explored as part of the Analysing Data, Recognising Excellence and Optimising Outcomes (ARO) Chronic Kidney Disease (CKD) Research Initiative.

METHODS

The association between the markers of mineral and bone disease and clinical outcomes was examined in 7970 patients treated in European Fresenius Medical Care facilities over a median of 21 months. Baseline and time-dependent (TD) Cox regression were performed using Kidney Disease Outcomes Quality Initiative (KDOQI) target ranges as reference categories, adjusting for demographics, medical history, dialysis parameters, inflammation, medications and laboratory parameters. Fractional polynomial (FP) models were also used.

RESULTS

Hazard ratio (HR) estimates from baseline analysis for iPTH were U-shaped [>600 pg/mL, HR = 2.10, 95% confidence interval (CI) 1.62-2.73; <75 pg/mL, HR = 1.46, 95% CI 1.17-1.83]. TD analysis confirmed the results for iPTH. Baseline analysis showed that calcium >2.75 mmol/L increased risk of death (HR = 1.70, 95% CI 1.19-2.42). TD analysis showed that both low (HR = 1.19, 95% CI 1.04-1.37) and high calcium (HR = 1.74, 95% CI 1.30-2.34) increased risk of death. Baseline analysis for phosphate showed a U-shaped pattern (<1.13 mmol/L, HR = 1.18, 95% CI 1.01-1.37; >1.78 mmol/L, HR = 1.32, 95% CI 1.13-1.55). TD analysis confirmed the results for phosphate <1.13 mmol/L. HR estimates were higher in patients with diabetes versus those without diabetes for baseline analysis only (P-value = 0.014). FP analysis confirmed the results of baseline and TD analyses.

CONCLUSION

Patients with iPTH, calcium and phosphate levels within the KDOQI target ranges have the lowest risk of mortality compared with those outside the target ranges.

Authors+Show Affiliations

Div. Nephrology, RWTH University of Aachen, Germany. juergen.floege@rwth-aachen.deNo 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 availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20466670

Citation

Floege, Jürgen, et al. "Serum iPTH, Calcium and Phosphate, and the Risk of Mortality in a European Haemodialysis Population." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 26, no. 6, 2011, pp. 1948-55.
Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant. 2011;26(6):1948-55.
Floege, J., Kim, J., Ireland, E., Chazot, C., Drueke, T., de Francisco, A., Kronenberg, F., Marcelli, D., Passlick-Deetjen, J., Schernthaner, G., Fouqueray, B., & Wheeler, D. C. (2011). Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 26(6), 1948-55. https://doi.org/10.1093/ndt/gfq219
Floege J, et al. Serum iPTH, Calcium and Phosphate, and the Risk of Mortality in a European Haemodialysis Population. Nephrol Dial Transplant. 2011;26(6):1948-55. PubMed PMID: 20466670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. AU - Floege,Jürgen, AU - Kim,Joseph, AU - Ireland,Elizabeth, AU - Chazot,Charles, AU - Drueke,Tilman, AU - de Francisco,Angel, AU - Kronenberg,Florian, AU - Marcelli,Daniele, AU - Passlick-Deetjen,Jutta, AU - Schernthaner,Guntram, AU - Fouqueray,Bruno, AU - Wheeler,David C, AU - ,, Y1 - 2010/04/25/ PY - 2010/5/15/entrez PY - 2010/5/15/pubmed PY - 2011/10/1/medline SP - 1948 EP - 55 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 26 IS - 6 N2 - BACKGROUND: A number of US observational studies reported an increased mortality risk with higher intact parathyroid hormone (iPTH), calcium and/or phosphate. The existence of such a link in a European haemodialysis population was explored as part of the Analysing Data, Recognising Excellence and Optimising Outcomes (ARO) Chronic Kidney Disease (CKD) Research Initiative. METHODS: The association between the markers of mineral and bone disease and clinical outcomes was examined in 7970 patients treated in European Fresenius Medical Care facilities over a median of 21 months. Baseline and time-dependent (TD) Cox regression were performed using Kidney Disease Outcomes Quality Initiative (KDOQI) target ranges as reference categories, adjusting for demographics, medical history, dialysis parameters, inflammation, medications and laboratory parameters. Fractional polynomial (FP) models were also used. RESULTS: Hazard ratio (HR) estimates from baseline analysis for iPTH were U-shaped [>600 pg/mL, HR = 2.10, 95% confidence interval (CI) 1.62-2.73; <75 pg/mL, HR = 1.46, 95% CI 1.17-1.83]. TD analysis confirmed the results for iPTH. Baseline analysis showed that calcium >2.75 mmol/L increased risk of death (HR = 1.70, 95% CI 1.19-2.42). TD analysis showed that both low (HR = 1.19, 95% CI 1.04-1.37) and high calcium (HR = 1.74, 95% CI 1.30-2.34) increased risk of death. Baseline analysis for phosphate showed a U-shaped pattern (<1.13 mmol/L, HR = 1.18, 95% CI 1.01-1.37; >1.78 mmol/L, HR = 1.32, 95% CI 1.13-1.55). TD analysis confirmed the results for phosphate <1.13 mmol/L. HR estimates were higher in patients with diabetes versus those without diabetes for baseline analysis only (P-value = 0.014). FP analysis confirmed the results of baseline and TD analyses. CONCLUSION: Patients with iPTH, calcium and phosphate levels within the KDOQI target ranges have the lowest risk of mortality compared with those outside the target ranges. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/20466670/Serum_iPTH_calcium_and_phosphate_and_the_risk_of_mortality_in_a_European_haemodialysis_population_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfq219 DB - PRIME DP - Unbound Medicine ER -