Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: A longitudinal study

Michal L. Melamed, J. A. Eustace, L. Plantinga, B. G. Jaar, N. E. Fink, J. Coresh, M. J. Klag, N. R. Powe

Research output: Contribution to journalArticle

271 Citations (Scopus)

Abstract

Elevated bone mineral parameters have been associated with mortality in dialysis patients. There are conflicting data about calcium, parathyroid hormone (PTH), and mortality and few data about changes in bone mineral parameters over time. We conducted a prospective cohort study of 1007 incident hemodialysis and peritoneal dialysis patients. We examined longitudinal changes in bone mineral parameters and whether their associations with mortality were independent of time on dialysis, inflammation, and comorbidity. Serum calcium, phosphate, and calcium-phosphate product (CaP) increased in these patients between baseline and 6 months (P<0.001) and then remained stable. Serum PTH decreased over the first year (P<0.001). In Cox proportional hazards models adjusting for inflammation, comorbidity, and other confounders, the highest quartile of phosphate was associated with a hazard ratio (HR) of 1.57 (1.07-2.30) using both baseline and time-dependent values. The highest quartiles of calcium, CaP, and PTH were associated with mortality in time-dependent models but not in those using baseline values. The lowest quartile of PTH was associated with an HR of 0.65 (0.44-0.98) in the time-dependent model with 6-month lag analysis. We conclude that high levels of phosphate both at baseline and over follow-up are associated with mortality in incident dialysis patients. High levels of calcium, CaP, and PTH are associated with mortality immediately preceding an event. Promising new interventions need to be rigorously tested in clinical trials for their ability to achieve normalization of bone mineral parameters and reduce deaths of dialysis patients.

Original languageEnglish (US)
Pages (from-to)351-357
Number of pages7
JournalKidney International
Volume70
Issue number2
DOIs
StatePublished - Jul 7 2006
Externally publishedYes

Fingerprint

Parathyroid Hormone
Longitudinal Studies
Dialysis
Minerals
Mortality
Serum
Bone and Bones
Calcium
Comorbidity
Phosphates
Inflammation
Peritoneal Dialysis
Proportional Hazards Models
Renal Dialysis
calcium phosphate
Cohort Studies
Clinical Trials
Prospective Studies

Keywords

  • Clinical epidemiology
  • Dialysis
  • Epidemiology and outcomes
  • Hospitalization
  • Mortality risk

ASJC Scopus subject areas

  • Nephrology

Cite this

Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients : A longitudinal study. / Melamed, Michal L.; Eustace, J. A.; Plantinga, L.; Jaar, B. G.; Fink, N. E.; Coresh, J.; Klag, M. J.; Powe, N. R.

In: Kidney International, Vol. 70, No. 2, 07.07.2006, p. 351-357.

Research output: Contribution to journalArticle

Melamed, Michal L. ; Eustace, J. A. ; Plantinga, L. ; Jaar, B. G. ; Fink, N. E. ; Coresh, J. ; Klag, M. J. ; Powe, N. R. / Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients : A longitudinal study. In: Kidney International. 2006 ; Vol. 70, No. 2. pp. 351-357.
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