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.
Morrone
Luigi Francesco
LF
Renal Division, A.O. Rummo, Benevento, Italy. l.morrone@fastwebnet.it
Mazzaferro
Sandro
S
Russo
Domenico
D
Aucella
Filippo
F
Cozzolino
Mario
M
Facchini
Maria Grazia
MG
Galfrè
Andrea
A
Malberti
Fabio
F
Mereu
Maria Cristina
MC
Nordio
Maurizio
M
Pertosa
Giovanni
G
Santoro
Domenico
D
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