Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Sampaio, Marcelo Santos; Molnar, Miklos Z.; Kövesdy, Csaba P.; Mehrotra, Rajnish; Mucsi, István; Sim, John J.; Krishnan, Mahesh; Nissenson, Allen R.; Kalantar-Zadeh, Kamyar

doi:10.2215/cjn.06190611

Cited by 20 publications

(21 citation statements)

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“…Several studies have shown associations between serum phosphorus levels and decline in renal function in pediatric and adult patients with CKD (8-10), and graft failure in adult renal transplant patients (11,(13)(14)(15). Serum phosphorus levels above recommended targets were associated with a higher risk of graft loss, even after adjustment for eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in children (8) and adult patients with early (9) or advanced CKD (10), serum phosphorus was independently associated with a decline in renal function. Moreover, donor (11), pretransplant (12,13), and post-transplant (14-16) mineral levels have been associated with graft failure in adult renal graft recipients. Information on mineral metabolism in pediatric graft recipients mainly originates from small single-center studies with relatively short follow-up time (5,17,18).…”

Section: Introductionmentioning

confidence: 99%

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Mineral Metabolism in European Children Living with a Renal Transplant

Bonthuis¹,

Busutti²,

Stralen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Data on mineral metabolism in pediatric renal transplant recipients largely arise from small single-center studies. In adult patients, abnormal mineral levels are related to a higher risk of graft failure. This study used data from the European Society for Paediatric Nephrology/European Renal AssociationEuropean Dialysis and Transplant Association Registry to study the prevalence and potential determinants of mineral abnormalities, as well as the predictive value of a disturbed mineral level on graft survival in a large cohort of European pediatric renal transplant recipients.Design, setting, participants, & measurements This study included 1237 children (0-17 years) from 10 European countries, who had serum calcium, phosphorus, and parathyroid hormone measurements from 2000 onward. Abnormalities of mineral metabolism were defined according to European guidelines on prevention and treatment of renal osteodystrophy in children on chronic renal failure.Results Abnormal serum phosphorus levels were observed in 25% (14% hypophosphatemia and 11% hyperphosphatemia), altered serum calcium in 30% (19% hypocalcemia, 11% hypercalcemia), and hyperparathyroidism in 41% of the patients. A longer time since transplantation was associated with a lower risk of having mineral levels above target range. Serum phosphorus levels were inversely associated with eGFR, and levels above the recommended targets were associated with a higher risk of graft failure independently of eGFR.Conclusions Abnormalities in mineral metabolism are common after pediatric renal transplantation in Europe and are associated with graft dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mineral Metabolism in European Children Living with a Renal Transplant

Bonthuis¹,

Busutti²,

Stralen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…The creation of the cohort has been described previously [28,29,30,31,32,33,34,35]. To minimize measurement variability, all repeated measures for each patient during any given calendar quarter, i.e.…”

Section: Methodsmentioning

confidence: 99%

Mortality Associated with Dose Response of Erythropoiesis-Stimulating Agents in Hemodialysis versus Peritoneal Dialysis Patients

et al. 2012

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Background: Several studies have shown an association between erythropoietin-stimulating agent (ESA) responsiveness and mortality in chronic kidney disease (CKD) patients. In our present study, we examined the association between prescribed ESA dose and mortality in peritoneal dialysis (PD) and hemodialysis (HD) patients. We hypothesized that PD patients received lower ESA dose for the same achieved hemoglobin compared to HD patients and that ESA dose-mortality associations were different between PD and HD patients. Methods: We compared the prescribed doses of ESA between 139,103 HD and 10,527 PD patients treated in DaVita dialysis clinics from 7/2001 through 6/2006 using adjusted Poisson regression and examined mortality-predictability of prescribed ESA dose and ESA responsiveness index (ESA/hemoglobin) in PD and HD with follow-up through 6/2007 using Cox regression models. Results: Poisson adjusted ratio of ESA dose of HD to PD was 3.6 (95% CI 3.5–3.7). In PD patients, adjusted all-cause death hazard ratios (HR) for ESA doses of 3,000–5,999, 6,000–8,999 and ≧9,000 U/week (reference <3,000 U/week) were 0.97 (0.87–1.07), 0.85 (0.76–0.95) and 1.08 (0.98–1.18), respectively; whereas in HD patients across commensurate ESA dose increments of 10,000–19,999, 20,000–29,999 and ≧30,000 U/week (reference <10,000 U/week) were 1.14 (1.11–1.17), 1.54 (1.50–1.58) and 2.15 (2.10–2.21), respectively. In PD and HD patients, the adjusted death HR of the 4th to 1st quartile of ESA responsiveness index were 1.14 (1.04–1.26) and 2.37 (2.31–2.43), respectively. Conclusions: Between 2001 and 2006, most PD patients received substantially lower ESA dose for same achieved hemoglobin levels, and low ESA responsiveness was associated with higher mortality in both HD and PD patients.

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“…Compared with a pretransplant serum PTH level of 100 pg/ml, pretransplant PTH levels of 300 pg/ml, 500 pg/ml, and 800 pg/ ml were associated with approximately 20%, 40%, and 80% higher risk of graft failure censored death, respectively (13). Similarly to PTH, pretransplant (12) and post-transplant (15) serum phosphorous levels were associated with increased mortality risk in kidney transplant recipients.…”

Section: Introductionmentioning

confidence: 95%

“…However, only few studies aimed to analyze the association between pretransplant MBDs and post-transplant outcome. We recently examined only the association of pretransplant phosphorus level and post-transplant outcome (12). However, similar investigations for other routinely measured MBD measures, such as alkaline phosphatase, intact parathyroid hormone (iPTH), and calcium, have not yet been examined in a large cohort.…”

Section: Introductionmentioning

confidence: 99%

Association of Pre–Kidney Transplant Markers of Mineral and Bone Disorder with Post-Transplant Outcomes

Molnar¹,

Kövesdy²,

Mucsi³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Mineral and bone disorders (MBDs) are common in long-term dialysis patients and are risk factors for unfavorable outcomes. The associations between pretransplant levels of MBD surrogates and outcomes after kidney transplantation are not clear. States. All dialysis patients who received a kidney transplant during this period were identified and divided into groups according to increments of pretransplant MBD markers. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined.Results The 11,776 patients were aged 47614 years and 39% were women. Compared with recipients with pretransplant time-averaged serum alkaline phosphatase of 80-120 U/L, recipients with pretransplant serum alkaline phosphatase of 120-160 and $160 U/L had 49% and 64% higher graft failure censored all-cause mortality in multivariable adjusted models. There was no significant association between time-averaged serum alkaline phosphatase categories and risk of death censored graft failure, delayed graft function (DGF), or acute rejection (AR). Compared with recipients with pretransplant time-averaged serum parathyroid hormone (PTH) levels of 150-300 pg/ml, there was no significant association with graft censored death among recipients with pretransplant serum PTH $800 pg/ml. In addition, the risk of graft failure, DGF, and AR did not show any association with time-averaged serum intact PTH level. There was no significant association between timeaveraged serum calcium categories and risk of graft failure censored death, DGF, and AR.Conclusions In this cohort, hemodialysis patients with pretransplant serum alkaline phosphatase .120 U/L have unfavorable post-transplant mortality, whereas there was no association between serum PTH and serum calcium levels and post-transplant outcomes.

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Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Cited by 20 publications

References 50 publications

Mineral Metabolism in European Children Living with a Renal Transplant

Mineral Metabolism in European Children Living with a Renal Transplant

Mortality Associated with Dose Response of Erythropoiesis-Stimulating Agents in Hemodialysis versus Peritoneal Dialysis Patients

Association of Pre–Kidney Transplant Markers of Mineral and Bone Disorder with Post-Transplant Outcomes

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