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Association of serum mineral parameters with mortality in hemodialysis patients: Data from the korean end-stage renal disease registryopen access

Authors
Kim Y.Yoo K.D.Kim H.J.Koh J.Yu Y.Kwon Y.J.Kim G.-H.Yoo T.-H.Lee J.Jin D.-C.Choi B.S.Kim Y.H.Oh K.-H.
Issue Date
2018
Publisher
The Korean Society of Nephrology
Keywords
Calcium; Hemodialysis; Mortality; Parathyroid hormone; Phosphorus
Citation
Kidney Research and Clinical Practice, v.37, no.3, pp.266 - 276
Indexed
SCOPUS
KCI
Journal Title
Kidney Research and Clinical Practice
Volume
37
Number
3
Start Page
266
End Page
276
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/4202
DOI
10.23876/j.krcp.2018.37.3.266
ISSN
2211-9132
Abstract
Background: We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients. Methods: Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed. Results: Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; P = 0.003). Conclusion: In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality. © 2018 by The Korean Society of Nephrology.
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Kwon, Young Joo
구로병원 (Department of Nephrology and Hypertension, Guro Hospital)
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