Disorders in bone-mineral parameters and the risk of death in persons with chronic kidney disease stages 4 and 5: the PECERA study
| Autor: | Elena Gimenez-Civera, Luis M Pallardó, Verónica Escudero, Mariola D Molina, Pilar Sánchez-Pérez, Ana Peris, Luis D'Marco, Luis Álvarez, Miguel Gonzalez-Rico, Jose E. Fernandez-Najera, María Jesús Puchades, José Luis Górriz, Javier Torralba, Pablo Molina, Juan Jesus Carrero |
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| Přispěvatelé: | Universidad de Alicante. Departamento de Matemáticas, Bioquímica Aplicada/Applied Biochemistry (AppBiochem), Grupo de Estadística Aplicada (GESTA) |
| Rok vydání: | 2021 |
| Předmět: |
Nephrology
medicine.medical_specialty medicine.medical_treatment Population 030232 urology & nephrology Phosphate 030204 cardiovascular system & hematology Gastroenterology Cohort Studies 03 medical and health sciences 0302 clinical medicine Renal Dialysis Estadística e Investigación Operativa Internal medicine Chronic kidney disease medicine Humans Prospective Studies Renal Insufficiency Chronic education Survival analysis Dialysis Bone mineral Hyperparathyroidism education.field_of_study Minerals business.industry Proportional hazards model Calcium Chronic kidney disease Hyperparathyroidism Phosphate Survival analysis medicine.disease Parathyroid Hormone Calcium business Kidney disease |
| Zdroj: | JOURNAL OF NEPHROLOGY r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe instname r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante r-FISABIO: Repositorio Institucional de Producción Científica Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) Journal Of Nephrology r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA r-FISABIO. Repositorio Institucional de Producción Científica |
| ISSN: | 1121-8428 |
| Popis: | Background Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). Methods PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicenter, open-cohort study of 966 adult patients with non-dialyzed CKD stages 4-5 enrolled from 12 centers in Spain. Associations between levels of serum calcium (Ca) (corrected for albumin), phosphate (P), and intact parathyroid hormone (iPTH) with all-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical values collected every 6 months for 3 years. Results After a median follow-up of 29 months (IQR: 13-36 months) there were 181 deaths (19%). The association of calcium with all-cause mortality was J-shaped, with an increased risk for all-cause mortality at levels > 10.5 mg/dL. For phosphate and iPTH levels, the association was U-shaped. The serum values associated with the minimum risk of mortality were 3.8 mg/dL for phosphate and 70 pg/mL for iPTH, being the lowest risk ranges between 2.8 and 5.0 mg/dL, and between 38 and 112 pg/mL for phosphate and iPTH, respectively. Conclusions Our study provides evidence on the non-linear association of serum calcium, phosphate and iPTH levels with mortality in stage 4 and 5 CKD patients, and suggests potential survival benefits for controlling bone mineral parameters in this population, as previously reported for dialysis patients. |
| Databáze: | OpenAIRE |
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