title: Hypercalcaemia is associated with poor mental health in haemodialysis patients: results from Japan DOPPS.
abstract: BACKGROUND
  The Dialysis Outcomes and Practice Patterns Study (DOPPS) reported high incidence of depression in haemodialysis patients. Hypercalcaemia and high parathyroid hormone (PTH) levels are aetiological factors of psychological disorders. We examined the association between mineral metabolism abnormalities and mental health in Japanese-DOPPS patients.
  
  
  METHODS
  We used baseline data of Japan-DOPPS, Phase 1 (2755 patients, 1999-2001) and Phase 2 (2286 patients, 2002-03). The outcome variable was mental health using the mental health domain of SF-36. We examined the association between serum corrected calcium, phosphorus, calcium x phosphorus product and intact PTH concentrations, and mental health using analysis of covariance and also the associations between corrected calcium levels and current use of vitamin D and calcium-containing phosphate binder.
  
  
  RESULTS
  There was a significant association between mental health and corrected calcium levels. A significantly lower mental health score was noted in patients with corrected calcium > or = 11 mg/dl than in <8.4 (P = 0.04), > or =8.4 to <10.2 (P = 0.009) and > or =10.2 to <11 mg/dl (P = 0.003). The association was significant even after adjustment for age, sex and other confounders. However, there was no relationship between intact PTH and mental health. High-corrected calcium levels were significantly associated with the use of intravenous active vitamin D and calcium-containing phosphate binder.
  
  
  CONCLUSIONS
  Hypercalcaemia, but not high intact PTH, is associated with poor mental health in dialysis patients. While a cause-effect relationship between hypercalcaemia and deterioration of mental health needs further confirmation by longitudinal and prospective studies, our observational findings suggest the importance of control of serum calcium concentration in dialysis patients.
authors.affiliation: Department of Nephrology, Akebono Clinic 5-1-1, Shirafuji, Kumamoto 561-4112, Japan. tanaka@matusita-kai.or.jp
authors.forename: Motoko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Shin
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Hayashino
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asano
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology* / Q000378:metabolism*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology* / Q000378:metabolism / Q000523:psychology*; D007564:Japan; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome