Roles of Serum Calcium, Phosphorus, PTH and ALP on Mortality in Peritoneal Dialysis Patients: A Nationwide, Population-based Longitudinal Study Using TWRDS 2005–2012

Abstract

Biomarkers of chronic kidney disease-mineral and bone disorder (CKD-MBD) correlate with morbidity and mortality in dialysis patients. However, the comparative roles of each CKD-MBD biomarker remained undetermined on long-term peritoneal dialysis (PD) patients. This retrospective study, employing a population-based database, aimed to evaluate the performance and provide the best evidence of each biomarker of CKD-MBD as predictor of all-cause mortality. Throughout the 8-year study period, total 12,116 PD patients were included in this study. Cox proportional regression and Kaplan-Meier method were used for survival analysis. For Cox regression model, baseline measurements and time-varying covariates were used for analysis. In Cox regression model using time-dependent covariates, serum calcium level of ≧9.5 mg/dL was associated with increased mortality. For phosphorus, serum levels of either ≧6.5 mg/dL or <3.5 mg/dL were associated with increased mortality. For parathyroid hormone (PTH), higher serum levels were not associated increased mortality. For alkaline phosphatase (ALP), mortality increased at levels ≧100 IU/L. Our findings suggested that the detrimental effect of ALP on survival was more consistent, while serum calcium, phosphorus and PTH may have a less prominent effect on mortality. This study provided additional information for manipulating CKD-MBD biomarkers in PD patients.

Total Bilirubin in Prognosis for Mortality in End‐Stage Renal Disease Patients on Peritoneal Dialysis Therapy

“…According to recent investigations by other researchers, the reported 3‐year mortality rate of various different races is ≈30±5% 4, 6, 19, 20, 21. The 3‐year overall mortality rate of our whole PD cohort was similar to the cohorts in previous studies.…”

“…There is a need to optimize the prediction of the clinical trajectory of these patients, and a search for other biomarkers that could delineate the clinical outcomes of PD patients is ongoing. Numerous novel biomarkers have been advocated for this purpose, such as alkaline phosphatase 6. Nevertheless, several unexplored biomarkers exist.…”

Association Between Comprehensive Nutritional Scoring System (CNSS) and Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients

“…In china, the number of ESRD patients receiving PD therapy is rapidly growing in recent years [37]. Patients on long-term dialysis have a significantly increased risk of mortality, and cardiovascular disease (CVD) and infection are most common causes of death in dialysis patients [38,39] have shown a variety of risk factors that predict the outcomes of dialysis patients, including age [40], sex [41], RRF [42], blood pressure [43,44], comorbidity [45], BMI [46][47][48][49], serum ALB [50,51], pre-ALB [52][53][54], TC [55][56][57][58], TG [59,60], VLDL [61], HB [62], Ca, P [63], PTH, ALP [64], UA [65,66], K, CRP [67], dialysis adequacy [68,69], incident peritonitis [70,71] and so on. Much effort has been done to maintain stable blood pressure, correct anemia and electrolyte disturbance as well as ensure dialysis adequacy and prevent peritonitis, in order to improve the long-term outcomes of dialysis patients.…”

Effect of Ascorbic Acid on Mineral and Bone Disorders in Hemodialysis Patients: a Systematic Review and Meta-Analysis

“…It was likewise advised that ALP levels were more consistent with mortality than PTH, Ca and P concentrations [43,44]. Moreover, bone-specific alkaline phosphatase (bALP) is still considered valuable as a marker of bone turnover [18] because bALP contributes to the diagnosis, fracture risk prediction and fracture prognosis of CKD-MBD patients.…”