Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry

Abstract

BackgroundWe investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients.MethodsAmong hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed.ResultsAmong 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71–0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20–1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08–1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02–1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05–1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12–1.67; P = 0.003).ConclusionIn Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.

Alterations in the Mineral Bone Metabolism of Living Kidney Donors After Uni-Nephrectomy: Prospective Observational Study

“…It is well known that most patients with chronic kidney disease (CKD) show a progressive deterioration in mineral homeostasis. These changes have been associated with a complex state termed CKD-mineral and bone disorder (CKD-MBD), which can exhibit fragility fractures, vascular calcification, and cardiovascular disease or mortality (1)(2)(3)(4). As the renal function declines, the ability of the kidneys to appropriately excrete a phosphate load is reduced leading to hyperphosphatemia, elevated parathyroid hormone (PTH), and decreased calcitriol with the associated elevations in the levels of fibroblast growth factor-23 (FGF-23) (5,6).…”

Low parathyroid hormone level predicts infection-related mortality in incident dialysis patients: a prospective cohort study

“…Most epidemiologic studies reported that higher serum iPTH level is associated with increased all-cause mortality in dialysis patients [1][2][3]. However, the impact of iPTH level on mortality is controversial in dialysis patients [4][5][6].…”

Hyperphosphatemia is not significantly associated with increased all-cause mortality in Korean hemodialysis patients

“…Also noteworthy is that dietary sources of phosphorus in Korean hemodialysis patients may differ from those of other countries. Nonetheless, we believe the study by Kim et al [1] provides insight that could help reduce the burden of hyperphosphatemia, a common problem among dialysis populations throughout the world.…”

“…We read the paper entitled “Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry” by Kim et al [1] with great interest. Using data from the nationwide Korean Society of Nephrology ESRD Registry, the authors revealed that high serum calcium, low phosphorus, and both high and low intact parathyroid hormone levels were associated with increased all-cause mortality.…”

“…A nationwide cohort study using data from the Japanese Society for Dialysis Therapy Registry found that poor performance status attenuated the effect of hyperphosphatemia on mortality in Japanese dialysis patients [2]. Although detailed information about performance status was not reported in the study by Kim et al [1], functional impairment and frailty are commonly observed in dialysis patients, especially in elderly dialysis patients.…”