title: Calcium, phosphorus, cardiovascular events and all-cause mortality in hemodialysis patients: a single-center retrospective cohort study to reassess the validity of the Japanese Society for Dialysis Therapy guidelines.
abstract: Mineral and bone disorders frequently cause cardiovascular complications and mortality in hemodialysis patients, but few observational studies of Japanese patients have investigated this matter. A retrospective cohort study of 99 patients (53 males, 46 females; mean age: 65 +/- 12 year; 38% with diabetes mellitus) on maintenance hemodialysis in our dialysis center was conducted. Mean serum Ca, P and intact parathyroid hormone (iPTH) levels were 9.2 +/- 0.9 mg/dL, 6.1 +/- 1.7 mg/dL, and 233 +/- 333 pg/mL, respectively. The cutoff values for each of these three parameter were defined according to the target ranges recommended by the Japanese Society for Dialysis Therapy (JSDT) guidelines (Ca: 8.4-10.0 mg/dL; P: 3.5-6.0 mg/dL; iPTH: 60-180 pg/mL). During a 45-month follow up, patients with all parameters outside the target ranges showed the highest incidence of cardiovascular events and all-cause deaths (16.6 and 29.2 per 1000 person-years, respectively). The relative risks of cardiovascular events and all-cause deaths were analyzed by multivariate Cox regression models. The hazard ratio (HR) for cardiovascular events was significantly lower for patients who achieved serum Ca and P objectives compared with others (HR: 2.12; 95% CI: 1.04-4.34; P < 0.05), and similar differences were observed for all-cause deaths (HR: 3.10; 95% CI: 1.13-8.53; P < 0.05). However, the relationship between iPTH levels and each of the endpoints was less pronounced. The results of this study provide support for the JSDT guidelines, which give priority to the control of serum Ca and P levels over the control of parathyroid function.
authors.affiliation: Department of Internal Medicine, Takasago Municipal Hospital, Takasago, Japan. hkomaba@med.kobe-u.ac.jp
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Komaba
authors.forename: Naoya
authors.initials: N
authors.lastname: Igaki
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Takashima
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Goto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yokota
authors.forename: Hisako
authors.initials: H
authors.lastname: Komada
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takemoto
authors.forename: Maki
authors.initials: M
authors.lastname: Kohno
authors.forename: Hiraku
authors.initials: H
authors.lastname: Kadoguchi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hirosue
authors.forename: Takeo
authors.initials: T
authors.lastname: Goto
mesh_terms: D000368:Aged; D044466:Asian People; D002118:Calcium / Q000097:blood*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood*; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium