Aberrant serum parathyroid hormone, calcium, and phosphorus as risk factors for peritonitis in peritoneal dialysis patients

Abstract

Identifying modifiable risk factors of peritoneal dialysis (PD)-related peritonitis is of clinical importance in patient care. Mineral bone disease (MBD) has been associated with mortality and morbidity in end-stage kidney disease (ESKD) patients. However, its influence on PD related peritonitis due to altered host immunity remains elusive. This study investigated whether abnormal biomarkers of MBD are associated with the development of peritonitis in patients undergoing maintenance PD. We conducted a retrospective observational cohort study, analysing data derived from a nationwide dialysis registry database in Taiwan, from 2005 to 2012. A total of 5750 ESKD patients commencing PD therapy during this period were enrolled and followed up to 60 months or by the end of the study period. The patients were stratified based on their baseline serum parathyroid hormone (PTH) levels, calcium (Ca) levels or phosphorus (P) levels, respectively or in combinations. The primary outcome was the occurrence of first episode of peritonitis, and patient outcomes such as deaths, transfer to haemodialysis or receiving renal transplantation were censored. Peritonitis-free survival and the influence of PTH, Ca, P (individual or in combination) on the peritonitis occurrence were analysed. A total of 5750 PD patients was enrolled. Of them, 1611 patients experienced their first episode of peritonitis during the study period. Patients with low PTH, high Ca or low P levels, respectively or in combination, had the lowest peritonitis-free survival. After adjusting for age, sex and serum albumin levels, we found that the combinations of low PTH levels with either high Ca levels or low/normal P levels were significant risk factors of developing peritonitis. Abnormal mineral bone metabolism in maintenance PD patients with low serum PTH levels, in combination with either high Ca levels or low/normal P levels, could be novel risk factors of PD-related peritonitis.

Relationship between serum iPTH and peritonitis episodes in patients undergoing continuous ambulatory peritoneal dialysis

“…A cohort study that included 270 patients who had PD revealed that, after adjusting for limited confounders, the multivariate analysis showed that lower serum PTH levels (with 150 pg/ml as a category) were independently associated with peritonitis in incident PD patients ( 55 ). Another retrospective, observational study showned that the unioncombinations of low PTH levels with either high Ca levels or with low/normal P levels wereas a considerable risk factors of for the occurrence of first episode of peritonitis in patients with undergoing PD ( 56 ).…”

High Plasma Levels of Fibroblast Growth Factor 23 Are Associated with Increased Risk of COVID-19 in End-Stage Renal Disease Patients on Hemodialysis: Results of a Prospective Cohort

“…Additionally, patients with high FGF23 levels also had high PTH levels. PTH is modulated by FGF23 [ 13 ], and low PTH levels have been associated with increased infection rates in ESRD patients [ 34 , 35 ]. To decrease this bias, we used statistical adjustments, including potential confounding variables, such as multivariate regressions, to evaluate the association of FGF23 levels and adverse clinical outcomes regardless of other demographical and clinical variables.…”