Relationship between serum calcium or phosphate levels and mortality stratified by parathyroid hormone level: an analysis from the MBD-5D study

Abstract

Introduction There is limited evidence about the association between calcium and phosphate levels and mortality stratified by intact parathyroid hormone (iPTH) level. Methods We investigated whether differences in iPTH level affect the relationship between calcium and phosphate levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism (SHPT). Calcium and phosphate levels were categorized as low (< 8.5 mg/dL, < 4.0 mg/dL), medium (≥ 8.5-< 9.5 mg/dL, ≥ 4.0-< 7.0 mg/dL), and high (≥ 9.5 mg/ dL, ≥ 7.0 mg/dL), respectively. iPTH levels were grouped into < 300 or ≥ 300 pg/mL. Adjusted incidence rate ratios (aIRRs) were analyzed by weighted Poisson regression. Results For calcium, patients with higher iPTH (≥ 300 pg/mL) had significantly higher all-cause mortality rates in the high than in the medium category (aIRR 1.99, 95% confidence interval [CI] 1.16-3.42), and tended to have a higher mortality rate in the low category (aIRR 2.04, 95% CI 0.94-4.42). Patients with lower iPTH (< 300 pg/mL) had higher mortality rates in the high than in the medium category (aIRR 1.65, 95% CI 1.39-1.96). For phosphate, the mortality rate was significantly higher in the high than in the medium category in patients with higher and lower iPTH (aIRR 3.23, 95% CI 1.63-6.39 for iPTH ≥ 300 pg/mL; aIRR 1.58, 95% CI 1.06-2.36 for iPTH < 300 pg/mL). Conclusion High calcium and phosphate levels were associated with increased risk of mortality irrespective of iPTH level.

The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients

“…Previous observational data suggested an association between abnormal biochemical markers of mineral metabolism and death [18][19][20][21][22]. However, the results of these studies were inconsistent [23][24][25][26][27][28]. Covic et al [29] made a meta-analysis with 19 studies that assessed the association between disturbances in biochemical parameters and all-cause mortality among patients on dialysis.…”

“…Previous observational data suggested an association between abnormal biochemical markers of mineral metabolism and death [ 18–22 ]. However, the results of these studies were inconsistent [ 23–28 ]. Covic et al.…”

Calcimimetic use in US hemodialysis facilities in first 2 years after the launch of etelcalcetide: A descriptive analysis of real‐world clinical practice and outcomes

“…Recent studies have shown the importance of starting treatment at lower phosphorus and PTH levels on long-term outcomes of SHPT and the ability to manage the disease and subsequent sequelae. [2][3][4]20 While prior research has shown that etelcalcetide is effective at all levels of severity of SHPT, the ability to achieve target goals was greatest, and dose requirement smallest, when etelcalcetide was initiated among patients with the lowest level of disease severity, as defined by PTH concentrations below 600 pg/ml at baseline. 21 Unmanaged SHPT may lead to parathyroidectomy, with the associated costs of an invasive surgery, and which encompasses additional complications and risk of cardiovascular events and hungry bone syndrome in dialysis patients.…”

“…1 Research has shown that consistent control of the three mineral and bone disease (MBD) biochemical parameters-PTH, calcium, and phosphorus-in hemodialysis patients was associated with better survival and improvements in other outcomes. [2][3][4] Calcimimetics are a class of drugs that reduce levels of PTH. Two calcimimetics-oral cinacalcet (Sensipar, Amgen, Thousand Oaks, CA) and intravenous etelcalcetide (Parsabiv, Amgen, Thousand Oaks, CA)-are approved for use in the United States.…”

“…Secondary hyperparathyroidism (SHPT) occurs often among patients with advanced chronic kidney disease who require treatment with dialysis (CKD‐5D), and it is characterized by elevated plasma parathyroid hormone (PTH) levels that arise due to alterations in calcium, phosphorus, and vitamin D metabolism caused by impaired kidney function 1 . Research has shown that consistent control of the three mineral and bone disease (MBD) biochemical parameters—PTH, calcium, and phosphorus—in hemodialysis patients was associated with better survival and improvements in other outcomes 2–4 …”