title: Associations among time-average mineral values, mortality and cardiovascular events in hemodialysis patients.
abstract: Mineral and bone disease (CKD-MBD), disorders of mineral metabolism, is associated with mortality and cardiovascular disease in dialysis patients. However, the associations among time average mineral values (P, Ca and PTH) and clinical outcomes are not well investigated.
  
  
  OBJECTIVE
  This study examines the associations among mineral values and clinical outcomes from a single medical center.
  
  
  METHODS
  Adult patients who initiate hemodialysis in Taoyuan General Hospital from 2008 to 2013 were enrolled. We examined these associations using baseline and time-average model. The clinical outcomes included mortality, major adverse cardiovascular events (MACE) and cardiovascular events. We also examined the association between achieve K/DOQI guidelines' targets and clinical outcomes.
  
  
  RESULTS
  From a total of 284 hemodialysis patients, none of the baseline mineral values is associated with mortality and cardiovascular event, except hyperphosphatemia. Compared to patients achieved K/DOQI guidelines' targets, time average hyperphosphatemia is associated with MACE and first cardiovascular event [the adjusted hazard ratios (AHRs) are 6.343 and 3.278); whereas time average hypercalcemia is associated with MACE marginally (the AHR is 5.964). None of above clinical outcomes is related to hyperparathyroidism. The AHRs for mortality in those who only met PTH targets and none of the mineral value targets are 1.73 and 1.74, whereas the AHRs for cardiovascular events in those who met only Ca, only PTH, and none of the targets are 1.73, 1.81 and 2.54 (all ps < 0.05).
  
  
  CONCLUSIONS
  Time-average phosphate is associated with cardiovascular events after initiation of dialysis. Among mineral values, serum phosphate is still the strongest predictor for mortality and cardiovascular events.
authors.affiliation: a Division of Nephrology, Department of Internal Medicine , Taoyuan General Hospital, Ministry of Health and Welfare , Taoyuan , Taiwan .|b College of Nursing, Chang Gung University of Science and Technology , Taoyuan , Taiwan .
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Wu
authors.affiliation: c Department of Physical Medicine and Rehabilitation , Cheng Hsin General Hospital , Taipei , Taiwan , and.
authors.forename: Lin-Chien
authors.initials: LC
authors.lastname: Lee
authors.affiliation: a Division of Nephrology, Department of Internal Medicine , Taoyuan General Hospital, Ministry of Health and Welfare , Taoyuan , Taiwan .|b College of Nursing, Chang Gung University of Science and Technology , Taoyuan , Taiwan .|d Department of Biomedical Engineering , Chung Yuan Christian University , Taoyuan , Taiwan.
authors.forename: Wei-Jie
authors.initials: WJ
authors.lastname: Wang
mesh_terms: D002118:Calcium / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D010710:Phosphates; D002118:Calcium
keywords: CKD-MBD; Cardiovascular events; major adverse cardiovascular event; mineral and bone disorder; mortality