Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis

Abstract

Background and aimIn spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients.MethodsThis prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC).ResultsAll-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher death rates. Low dialysis efficacy represented a risk factor for mortality and CDV diseases and events. In PD patients, low albumin induced a higher death rate. In PD patients the death rate was similar to HD patients.ConclusionAll-cause mortality was higher than in general population, but lower than the chronic dialysis patients’ mortality reported in other studies. The death rates in HD and PD patients were similar. VC and serum P levels influenced the outcome in the HD patients – increased the risk for all-cause and CDV mortality, but also for CDV events. ALP levels influenced outcome in PD patients. There were no significant differences between HD and PD patients regarding outcome.

CD62P and P10 as predictive markers for assessing the efficacy of hemodialysis in treating end‐stage renal disease

“…The various causes of ESRD, such as aging, increased number of patients with hypertension and metabolic syndrome, and the lack of awareness on the prevention and diagnosis of CKD seriously contribute to the gradually increasing incidence of CKD in china, with the disease occurrence reaching around 10.8% in 2012, further intensifying incidence of ESRD . Although a widely adopted renal replacement therapy—hemodialysis (HD) has been constantly improved with the growing insight into various HD complications, the prognosis of HD patients is still poor and the morbidity and mortality rates after HD treatment still remain high . Based on the fact that HD helps to remove the extracorporeal waste products such as toxins and free water in order to correct the electrolyte and acid‐base imbalances, researchers are exploring valuable molecular targets to improve HD efficacy.…”

Relationship between serum calcium level at dialysis initiation and subsequent prognosis

“…Increased serum calcium levels reportedly cause vascular calcification and carry a risk of CVD [10][11][12]. However, serum calcium levels often tend to decrease during the predialysis stage of CKD including the period immediately before dialysis initiation [13].…”

Long-term effects of low calcium dialysates on the serum calcium levels during maintenance hemodialysis treatments: A systematic review and meta-analysis

“…The serum Ca, P and iPTH levels are important therapeutic targets requiring proper control during maintenance HD treatments, but it is often difficult to achieve this because these parameters interact with each other. Hypercalcemia can cause the vascular calcifications that effect the risk of death 29 , while mild hypocalcemia without clinical symptoms is thought to be acceptable 9 . Severe HPT can increase the risk of bone fractures 30 , but the relatively low serum iPTH levels can lead to the low bone turnovers or ABD 31 .…”