Association of Parameters of Mineral Bone Disorder with Mortality in Patients on Hemodialysis according to Level of Residual Kidney Function

Clinical journal of the American Society of Nephrology: CJASN

Mengjing Wang¹ 

[1] *Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California;§Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;†Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China;‡Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Osaka, Japan

关键词: Mortality;    chronic kidney failure;    hemodialysis;    end stage kidney disease;    mineral metabolism;    renal function;    Albumins;    Alkaline Phosphatase;    calcium;    Follow-Up Studies;    Humans;    Minerals;    parathyroid hormone;    Phosphorus;    Phosphorus, Dietary;    Proportional Hazards Models;    renal dialysis;    Risk;    urea;    Urinary Tract Physiological Phenomena;   

DOI  :  10.2215/CJN.11931116

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives The relationship between mineral and bone disorders and survival according to residual kidney function status has not been previously studied in patients on hemodialysis. We hypothesized that residual kidney function, defined by renal urea clearance, modifies the association between mineral and bone disorder parameters and mortality.Design, setting, participants, & measurements The associations of serum phosphorus, albumin-corrected calcium, intact parathyroid hormone, and alkaline phosphatase with all-cause mortality were examined across three strata (<1.5, 1.5 to <3.0, and ≥3.0 ml/min per 1.73 m2) of baseline residual renal urea clearance using Cox models adjusted for clinical characteristics and laboratory measurements in 35,114 incident hemodialysis patients from a large United States dialysis organization over the period of 2007–2011.Results A total of 8102 (23%) patients died during the median follow-up of 1.3 years (interquartile range, 0.6–2.3 years). There was an incremental mortality risk across higher serum phosphorus concentrations, which was pronounced among patients with higher residual renal urea clearance (Pinteraction=0.001). Lower concentrations of serum intact parathyroid hormone were associated with higher mortality among patients with low residual renal urea clearance (i.e., <1.5 ml/min per 1.73 m2), whereas higher concentrations showed a higher mortality risk among patients with greater residual renal urea clearance (i.e., ≥1.5 ml/min per 1.73 m2; Pinteraction<0.001). Higher serum corrected total calcium and higher alkaline phosphatase concentrations consistently showed higher mortality risk (Ptrend<0.001 for both) irrespective of residual renal urea clearance strata (Pinteraction=0.34 and Pinteraction=0.53, respectively).Conclusions Residual kidney function modified the mortality risk associated with serum phosphorus and intact parathyroid hormone among incident hemodialysis patients. Future studies are needed to examine whether taking account for residual kidney function into the assessment of mortality risk associated with serum phosphorus and intact parathyroid hormone improves patient management and clinical outcomes in the hemodialysis population.

【 授权许可】

CC BY