Comparative Effectiveness of Dialysis Modality on Laboratory Parameters of Mineral Metabolism.

Autor:	Soohoo M; Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA., Obi Y; Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA., Rivara MB; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA., Adams SV; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA., Lau WL; Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA., Rhee CM; Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA., Kovesdy CP; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA.; Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA., Kalantar-Zadeh K; Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA., Arah OA; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA.; Department of Statistics, College of Letters and Science, University of California, Los Angeles (UCLA), Los Angeles, California, USA.; Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark., Mehrotra R; Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA., Streja E; Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, California, USA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.
Jazyk:	angličtina
Zdroj:	American journal of nephrology [Am J Nephrol] 2022; Vol. 53 (2-3), pp. 157-168. Date of Electronic Publication: 2022 Feb 28.
DOI:	10.1159/000521508
Abstrakt:	Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are prevalent in patients undergoing maintenance dialysis. Yet, there are limited and mixed evidence on the effects of different dialysis modalities involving longer treatment times or higher frequencies on CKD-MBD markers. Methods: This cohort study used data from 132,523 incident dialysis patients treated with any of the following modalities: conventional thrice-weekly in-center hemodialysis, nocturnal in-center hemodialysis (NICHD), home hemodialysis (HHD), or peritoneal dialysis (PD) from 2007 to 2011. We used marginal structural models fitted with inverse probability weights to adjust for fixed and time-varying confounding and informative censoring. We estimated the average effects of treatments with different dialysis modalities on time-varying serum concentrations of CKD-MBD markers: albumin-corrected calcium, phosphate, parathyroid hormone (PTH), and alkaline phosphatase (ALP) using pooled linear regression. Results: Most of the cohort were exclusively treated with conventional in-center hemodialysis, while few were ever treated with NICHD or HHD. At the baseline, PD patients had the lowest mean and median values of PTH, while NICHD patients had the highest median values. During follow-up, compared to hemodialysis patients, patients treated with NICHD had lower mean serum PTH (19.8 pg/mL [95% confidence interval: 2.8, 36.8] lower), whereas PD and HHD patients had higher mean PTH (39.7 pg/mL [31.6, 47.8] and 51.2 pg/mL [33.0, 69.3] higher, respectively). Compared to hemodialysis patients, phosphate levels were lower for patients treated with NICHD (0.44 mg/dL [0.37, 0.52] lower), PD (0.15 mg/dL [0.12, 0.19] lower), or HHD (0.33 mg/dL [0.27, 0.40] lower). There were no clinically meaningful associations between dialysis modalities and concentrations of calcium or ALP. Conclusion: In incident dialysis patients, compared to treatment with conventional in-center hemodialysis, treatments with other dialysis modalities with longer treatment times or higher frequency were associated with different patterns of serum phosphate and PTH. Given the recent growth in the use of dialysis modalities other than hemodialysis, the associations between the treatment and the CKD-MBD markers warrant additional study. (© 2022 The Author(s). Published by S. Karger AG, Basel.)
Databáze:	MEDLINE
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