title: Low parathyroid hormone status induced by high dialysate calcium is an independent risk factor for cardiovascular death in hemodialysis patients.
abstract: Here we studied a possible association between low parathyroid hormone (PTH) status and mortality in incident patients undergoing hemodialysis . A total of 1983 patients were included at baseline and prospectively followed for 24 months. Patients were classified according to their Kidney Disease: Improving Global Outcomes PTH status at baseline and at 12 months, and mortality evaluated at 12 to 24 months using adjusted Cox analysis. Factors potentially involved in PTH status variability between baseline and 12 months were analyzed. A decrease in serum PTH from normal or high to low values between baseline and 12 months was associated with significantly increased cardiovascular mortality at 12 to 24 months (hazard ratio, 2.03; 95% confidence interval, 1.22-3.36). For patients with high or normal baseline PTH levels, the main independent factor at 6 months for a decrease to low PTH levels at 12 months was high dialysate calcium (1.75 mmol/L), whereas prescription of non-calcium-based phosphate binders was associated with a lower risk of PTH decrease. In the high cardiovascular (CV) mortality risk subgroup of patients who acquired a low PTH status at 12 months, the main independent factor at 12 months associated with significant 12- to 24-month CV mortality was high dialysate calcium (odds ratio, 5.44; 95% CI, 2.52-11.75). Thus, patients with a serum PTH decrease to low values after 1 year of hemodialysis treatment are at high risk of short-term CV death. High dialysate calcium was an important contributor to PTH oversuppression, and continued use was associated with increased CV mortality.
authors.affiliation: Nephrology, Bichat Hospital, DHU FIRE, APHP, Paris Diderot University, INSERM U1149, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Merle
authors.affiliation: Centre de Recherche en Nutrition Humaine Rhône-Alpes, CHU-Grenoble, France and Inserm U1055-Bioénergétique, Université Grenoble Alpes, Grenoble, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Roth
authors.affiliation: Hôpital Manhes, Fleury-Mérogis, France.
authors.forename: Gérard M
authors.initials: GM
authors.lastname: London
authors.affiliation: Nephrocare Tassin-Charcot, Sainte Foy-les-lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.affiliation: Service de Néphrologie, Hôpitaux Universitaires de Strasbourg, and Faculté de Médecine, Strasbourg, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
authors.affiliation: Centre de Traitement des Maladies Rénales Saint-Augustin, Bordeaux, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bouchet
authors.affiliation: Inserm Unit 1088, UFR de Médecine et Pharmacie, Université de Picardie Jules Verne, Amiens, France.
authors.forename: Tilman
authors.initials: T
authors.lastname: Drüeke
authors.affiliation: Department of Nephrology, Hôpital Lyon Sud, Université de Lyon, CENS, Lyon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.affiliation: Nephrology, Bichat Hospital, DHU FIRE, APHP, Paris Diderot University, INSERM U1149, Paris, France. Electronic address: eric.daugas@bch.aphp.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Daugas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D002614:Chelating Agents / Q000627:therapeutic use; D015536:Down-Regulation; D005260:Female; D005602:France / Q000453:epidemiology; D015312:Hemodialysis Solutions / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D015312:Hemodialysis Solutions; C470125:PTH protein, human; D010281:Parathyroid Hormone; D002118:Calcium
keywords: KDIGO; cardiovascular mortality; dialysate calcium concentration; hemodialysis; low PTH