Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
| Autor: | Norma J. Ofsthun, J. Michael Lazarus, Preston S. Klassen, Glenn M. Chertow, Geoffrey A. Block, Edmund G. Lowrie |
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| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Cinacalcet Infections Gastroenterology Fractures Bone Hyperphosphatemia Arteriovenous Shunt Surgical Renal Dialysis Risk Factors Chronic kidney disease-mineral and bone disorder Internal medicine medicine Humans Aged Etelcalcetide Minerals Hyperparathyroidism business.industry Mortality rate Phosphorus General Medicine Middle Aged medicine.disease Hospitalization Endocrinology Cardiovascular Diseases Parathyroid Hormone Nephrology Cinacalcet Hydrochloride Kidney Failure Chronic Calcium Female Hyperparathyroidism Secondary Secondary hyperparathyroidism Morbidity business medicine.drug |
| Zdroj: | Journal of the American Society of Nephrology. 15:2208-2218 |
| ISSN: | 1046-6673 |
| DOI: | 10.1097/01.asn.0000133041.27682.a2 |
| Popis: | Mortality rates in ESRD are unacceptably high. Disorders of mineral metabolism (hyperphosphatemia, hypercalcemia, and secondary hyperparathyroidism) are potentially modifiable. For determining associations among disorders of mineral metabolism, mortality, and morbidity in hemodialysis patients, data on 40,538 hemodialysis patients with at least one determination of serum phosphorus and calcium during the last 3 mo of 1997 were analyzed. Unadjusted, case mix-adjusted, and multivariable-adjusted relative risks of death were calculated for categories of serum phosphorus, calcium, calcium x phosphorus product, and intact parathyroid hormone (PTH) using proportional hazards regression. Also determined was whether disorders of mineral metabolism were associated with all-cause, cardiovascular, infection-related, fracture-related, and vascular access-related hospitalization. After adjustment for case mix and laboratory variables, serum phosphorus concentrations >5.0 mg/dl were associated with an increased relative risk of death (1.07, 1.25, 1.43, 1.67, and 2.02 for serum phosphorus 5.0 to 6.0, 6.0 to 7.0, 7.0 to 8.0, 8.0 to 9.0, and >/=9.0 mg/dl). Higher adjusted serum calcium concentrations were also associated with an increased risk of death, even when examined within narrow ranges of serum phosphorus. Moderate to severe hyperparathyroidism (PTH concentrations >/=600 pg/ml) was associated with an increase in the relative risk of death, whereas more modest increases in PTH were not. When examined collectively, the population attributable risk percentage for disorders of mineral metabolism was 17.5%, owing largely to the high prevalence of hyperphosphatemia. Hyperphosphatemia and hyperparathyroidism were significantly associated with all-cause, cardiovascular, and fracture-related hospitalization. Disorders of mineral metabolism are independently associated with mortality and morbidity associated with cardiovascular disease and fracture in hemodialysis patients. |
| Databáze: | OpenAIRE |
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