Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study.
BACKGROUND
Mineral metabolism parameters may play a role in the survival of patients with chronic kidney disease (CKD).


METHODS
In the CORES Study, we analysed the association between calcium, phosphorus and PTH and mortality (all-cause and cardiovascular) in 16 173 haemodialysis (HD) patients over 18 years from six Latin American countries, who underwent haemodialysis up to 54 months. Unadjusted, case-mix-adjusted and time-dependent multivariable-adjusted hazard ratio (HR) of death were calculated for categories of serum albumin-corrected calcium (Ca(Alb)), phosphorus and PTH using as 'reference values' the range in which the lowest death rate was observed. Age, gender, vitamin D treatment, diabetes, vintage, vascular access, weight, blood pressure and laboratory variables (serum albumin, haemoglobin, creatinine, ferritin and Kt/V) were used as confounding variables.


RESULTS
Low (<9.5 mg/dL) and high (>10.5 mg/dL) Ca(Alb) increased the HR for all-cause mortality. Low (<9.0 mg/dL) Ca(Alb) increased the HR for cardiovascular mortality. High phosphorus (>5.5 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Low phosphorus (<4.0 and <3.0 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Furthermore, low (<150 pg/mL) and high (>500 and >300 pg/mL) PTH increased the HR for both all-cause and cardiovascular mortality. In addition, only phosphorus >6.0 mg/dL increased the HR for cardiovascular hospitalizations. No effect was observed with Ca(Alb) or PTH.


CONCLUSIONS
In summary, in 16,173 HD patients, elevated and reduced serum levels of albumin-corrected calcium, phosphorus and PTH levels were associated with increments in all-cause mortality. Similar results were obtained when only cardiovascular mortality was analysed.
Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, Universidad de Oviedo, Julián Claveria s/n, 33006 Oviedo, Spain.
Manuel
M
Naves-Díaz
Jutta
J
Passlick-Deetjen
Adrian
A
Guinsburg
Cristina
C
Marelli
Jose Luis
JL
Fernández-Martín
Diego
D
Rodríguez-Puyol
Jorge B
JB
Cannata-Andía
D002118:Calcium / Q000097:blood*; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality*; D007843:Latin America; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood*; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
D010281:Parathyroid Hormone; D010758:Phosphorus; D003404:Creatinine; D002118:Calcium