Interaction between parathyroid hormone and the Charlson comorbidity index on survival of incident haemodialysis patients.
BACKGROUND
Haemodialysis patients are ageing and have with a high rate of comorbidities. The impact of this novel clinical setting on intact parathyroid hormone (iPTH) is not well established.


METHODS
For this observational, prospective multicentre cohort study, incident haemodialysis patients were recruited in 40 Italian centres and followed up for a mean period of 18 +/- 6.7 months. Clinical characteristics and biochemistry were recorded at baseline. Comorbid conditions were scored by the Charlson comorbidity index (CCI).


RESULTS
Data of 411 patients (mean age: 66.5 +/- 14.8 years; 17.3% >80 years old) were recorded. The mean CCI was 4.17 +/- 2.8. In patients with CCI >0, an inverse correlation was observed between CCI (excluding age) and iPTH (P = 0.00002). Independently of CCI, patients with iPTH <150 pg/ml had 76% as high as the risk of all-cause mortality. After multivariable adjustment, the combination of the first tertile of iPTH with second and third tertiles of CCI was significantly associated with all-cause mortality (RR = 3.83, P = 0.02; RR = 3.79, P = 0.01, respectively).


CONCLUSIONS
Incident haemodialysis patients suffer from a high rate of clinical complications. In these patients, low iPTH and high CCI are often associated and very likely responsible for an adverse outcome.
Renal Division, A.O. Rummo, Benevento, Italy. l.morrone@fastwebnet.it
Luigi Francesco
LF
Morrone
Sandro
S
Mazzaferro
Domenico
D
Russo
Filippo
F
Aucella
Mario
M
Cozzolino
Maria Grazia
MG
Facchini
Andrea
A
Galfrè
Fabio
F
Malberti
Maria Cristina
MC
Mereu
Maurizio
M
Nordio
Giovanni
G
Pertosa
Domenico
D
Santoro
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D055815:Young Adult
D010281:Parathyroid Hormone