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Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study.
Nephrol Dial Transplant. 2011 Jun; 26(6):1938-47.ND

Abstract

BACKGROUND

Mineral metabolism parameters may play a role in the survival of patients with chronic kidney disease (CKD).

METHODS

In the CORES Study, we analysed the association between calcium, phosphorus and PTH and mortality (all-cause and cardiovascular) in 16 173 haemodialysis (HD) patients over 18 years from six Latin American countries, who underwent haemodialysis up to 54 months. Unadjusted, case-mix-adjusted and time-dependent multivariable-adjusted hazard ratio (HR) of death were calculated for categories of serum albumin-corrected calcium (Ca(Alb)), phosphorus and PTH using as 'reference values' the range in which the lowest death rate was observed. Age, gender, vitamin D treatment, diabetes, vintage, vascular access, weight, blood pressure and laboratory variables (serum albumin, haemoglobin, creatinine, ferritin and Kt/V) were used as confounding variables.

RESULTS

Low (<9.5 mg/dL) and high (>10.5 mg/dL) Ca(Alb) increased the HR for all-cause mortality. Low (<9.0 mg/dL) Ca(Alb) increased the HR for cardiovascular mortality. High phosphorus (>5.5 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Low phosphorus (<4.0 and <3.0 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Furthermore, low (<150 pg/mL) and high (>500 and >300 pg/mL) PTH increased the HR for both all-cause and cardiovascular mortality. In addition, only phosphorus >6.0 mg/dL increased the HR for cardiovascular hospitalizations. No effect was observed with Ca(Alb) or PTH.

CONCLUSIONS

In summary, in 16,173 HD patients, elevated and reduced serum levels of albumin-corrected calcium, phosphorus and PTH levels were associated with increments in all-cause mortality. Similar results were obtained when only cardiovascular mortality was analysed.

Authors+Show Affiliations

Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Universidad de Oviedo, Julián Claveria s/n, 33006 Oviedo, Spain.No 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

20513773

Citation

Naves-Díaz, Manuel, et al. "Calcium, Phosphorus, PTH and Death Rates in a Large Sample of Dialysis Patients From Latin America. the CORES Study." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 26, no. 6, 2011, pp. 1938-47.
Naves-Díaz M, Passlick-Deetjen J, Guinsburg A, et al. Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study. Nephrol Dial Transplant. 2011;26(6):1938-47.
Naves-Díaz, M., Passlick-Deetjen, J., Guinsburg, A., Marelli, C., Fernández-Martín, J. L., Rodríguez-Puyol, D., & Cannata-Andía, J. B. (2011). Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 26(6), 1938-47. https://doi.org/10.1093/ndt/gfq304
Naves-Díaz M, et al. Calcium, Phosphorus, PTH and Death Rates in a Large Sample of Dialysis Patients From Latin America. the CORES Study. Nephrol Dial Transplant. 2011;26(6):1938-47. PubMed PMID: 20513773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study. AU - Naves-Díaz,Manuel, AU - Passlick-Deetjen,Jutta, AU - Guinsburg,Adrian, AU - Marelli,Cristina, AU - Fernández-Martín,Jose Luis, AU - Rodríguez-Puyol,Diego, AU - Cannata-Andía,Jorge B, Y1 - 2010/05/31/ PY - 2010/6/2/entrez PY - 2010/6/2/pubmed PY - 2011/10/1/medline SP - 1938 EP - 47 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: Mineral metabolism parameters may play a role in the survival of patients with chronic kidney disease (CKD). METHODS: In the CORES Study, we analysed the association between calcium, phosphorus and PTH and mortality (all-cause and cardiovascular) in 16 173 haemodialysis (HD) patients over 18 years from six Latin American countries, who underwent haemodialysis up to 54 months. Unadjusted, case-mix-adjusted and time-dependent multivariable-adjusted hazard ratio (HR) of death were calculated for categories of serum albumin-corrected calcium (Ca(Alb)), phosphorus and PTH using as 'reference values' the range in which the lowest death rate was observed. Age, gender, vitamin D treatment, diabetes, vintage, vascular access, weight, blood pressure and laboratory variables (serum albumin, haemoglobin, creatinine, ferritin and Kt/V) were used as confounding variables. RESULTS: Low (<9.5 mg/dL) and high (>10.5 mg/dL) Ca(Alb) increased the HR for all-cause mortality. Low (<9.0 mg/dL) Ca(Alb) increased the HR for cardiovascular mortality. High phosphorus (>5.5 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Low phosphorus (<4.0 and <3.0 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Furthermore, low (<150 pg/mL) and high (>500 and >300 pg/mL) PTH increased the HR for both all-cause and cardiovascular mortality. In addition, only phosphorus >6.0 mg/dL increased the HR for cardiovascular hospitalizations. No effect was observed with Ca(Alb) or PTH. CONCLUSIONS: In summary, in 16,173 HD patients, elevated and reduced serum levels of albumin-corrected calcium, phosphorus and PTH levels were associated with increments in all-cause mortality. Similar results were obtained when only cardiovascular mortality was analysed. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/20513773/Calcium_phosphorus_PTH_and_death_rates_in_a_large_sample_of_dialysis_patients_from_Latin_America__The_CORES_Study_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfq304 DB - PRIME DP - Unbound Medicine ER -