Impact of calcium, phosphate, PTH abnormalities and management on mortality in hemodialysis: results from the RISCAVID study.
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.
Panichi
Vincenzo
V
Nephrology and Dialysis, Versilia Hospital, Lido di Camaiore, Italy. vpanichi@usl12.toscana.it
Bigazzi
Roberto
R
Paoletti
Sabrina
S
Mantuano
Emanuela
E
Beati
Sara
S
Marchetti
Valentina
V
Bernabini
Giada
G
Grazi
Giovanni
G
Giust
Riccardo
R
Rosati
Alberto
A
Migliori
Massimiliano
M
Pasquariello
Antonio
A
Panicucci
Erica
E
Barsotti
Giuliano
G
Bellasi
Antonio
A
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
D010281:Parathyroid Hormone; D010710:Phosphates; D011073:Polyamines; D000069603:Sevelamer; D002118:Calcium