title: Impact of calcium, phosphate, PTH abnormalities and management on mortality in hemodialysis: results from the RISCAVID study.
abstract: BACKGROUND
  Despite substantial progress in medical care, the mortality rate remains unacceptably high in dialysis patients. Evidence suggests that bone mineral dismetabolism (CKD-MBD) might contribute to this burden of death. However, to date only a few papers have investigated the clinical relevance of serum mineral derangements and the impact of different therapeutic strategies on mortality in a homogeneous cohort of south European dialysis patients.
  
  
  METHODS
  The RISCAVID study was a prospective, observational study in which all patients receiving hemodialysis (HD) in the north-western region of Toscany in June 2004 were enrolled (N=757) and followed up for 24 months.
  
  
  RESULTS
  At study entry, only 71 (9%) patients of the entire study cohort exhibited an optimal control of serum phosphorous (Pi), calcium (Ca), calciumX-phosphorous product (CAXPi) and intact parathyroidhormone (iPTH) according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical guidelines. Despite a similar prevalence, the severity of CKD-MBD appeared different to the results reported in the USA. Interestingly, none of the serum biomarkers or number of serum biomarkers within KDOQI targets was independently associated with all-cause and cardiovascular (CV) mortality. Among treatments, Sevelamer was the only drug independently associated with lower all-cause and cardiovascular mortality (p<0.001).
  
  
  CONCLUSIONS
  The RISCAVID study highlights the difficulty of controlling bone mineral metabolism in HD patients and lends support to the hypothesis that a carefully chosen phosphate binder might impact survival in HD patients.
authors.affiliation: Nephrology and Dialysis, Versilia Hospital, Lido di Camaiore, Italy. vpanichi@usl12.toscana.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panichi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bigazzi
authors.forename: Sabrina
authors.initials: S
authors.lastname: Paoletti
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mantuano
authors.forename: Sara
authors.initials: S
authors.lastname: Beati
authors.forename: Valentina
authors.initials: V
authors.lastname: Marchetti
authors.forename: Giada
authors.initials: G
authors.lastname: Bernabini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grazi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giust
authors.forename: Alberto
authors.initials: A
authors.lastname: Rosati
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Migliori
authors.forename: Antonio
authors.initials: A
authors.lastname: Pasquariello
authors.forename: Erica
authors.initials: E
authors.lastname: Panicucci
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barsotti
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
mesh_terms: D000368:Aged; D002118:Calcium / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010710:Phosphates / Q000097:blood*; D011073:Polyamines / Q000627:therapeutic use; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D000069603:Sevelamer
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D011073:Polyamines; D000069603:Sevelamer; D002118:Calcium