Changes in 3-month mineral and bone disorder patterns were associated with all-cause mortality in prevalent hemodialysis patients with secondary hyperparathyroidism

BMC Nephrology

Shunichi Fukuhara¹  Chisato Miyakoshi²  Naohiko Fujii³  Tadao Akizawa⁴  Masafumi Fukagawa⁵  Yoshihiro Onishi⁶  Shingo Fukuma⁷  Chihiro Kato⁸  Michihito Wada⁸  Takanobu Nomura⁸  Shinji Asada⁸ 

[1] Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan;Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan;Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan;Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan;Department of Internal Medicine (Nephrology Unit), Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan;Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan;Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan;Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan;Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan;Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan;The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan;Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, 100-0004, Tokyo, Japan;

关键词: Changing pattern;    CKD-MBD;    Hemodialysis;    Secondary hyperparathyroidism;    Mortality;   

DOI  :  10.1186/s12882-020-02088-x

来源: Springer

【 摘 要 】

BackgroundThere is limited evidence on the association between short-term changes in mineral and bone disorder parameters and survival in maintenance hemodialysis patients.MethodsWe investigated the association between changing patterns of phosphorus, calcium and intact parathyroid hormone levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism. Each parameter was divided into three categories (low [L], middle [M] and high [H]), and the changing patterns between two consecutive visits at 3-month intervals were categorized into nine groups (e.g., L-L and M-H). The middle category was defined as 4.0–7.0 mg/dL for phosphorous, 8.5–9.5 mg/dL for calcium and 200–500 pg/mL for intact parathyroid hormone. Adjusted incidence rates and rate ratios were analyzed by weighted Poisson regression models accounting for time-dependent exposures.ResultsFor phosphorus, shifts from low/high to middle category (L-M/H-M) were associated with a lower mortality compared with the L-L and H–H groups, whereas shifts from middle to low/high category (M-L/M-H) were associated with a higher mortality compared with the M-M group. For calcium, shifts from low/middle to high category (L–H/M-H) were associated with a higher mortality compared with the L-L and M-M groups, whereas shifts from high to middle category (H-M) were associated with a lower mortality compared with the H–H group. For intact parathyroid hormone, shifts from low to middle category (L-M) were associated with a lower mortality compared with the L-L group.ConclusionsChanges in the 3-month patterns of phosphorus and calcium toward the middle category were associated with lower mortality. Our study also suggests the importance of avoiding hypercalcemia.

【 授权许可】

CC BY