Association between the risk of death and serum calcium, phosphate, and intact parathyroid hormone levels in older patients undergoing maintenance hemodialysis: a cohort study in Beijing

Background: The number of patients ⩾65 years who require maintenance hemodialysis (MHD) is increasing. Although reduced bone turnover in older patients receiving hemodialysis, as reflected by lower serum intact parathyroid hormone (iPTH) and phosphate (P) levels, has been reported, focus on the association between abnormal bone metabolism and the risk of death in older patients receiving MHD has been limited. Methods: We retrospectively examined data from the Beijing Hemodialysis Quality Control and Improvement Center for 1410 older patients who underwent hemodialysis from 1 January 2012 to 31 December 2016. Baseline, time-dependent (TD) Cox proportional hazards models and Kaplan–Meier analyses were used to evaluate the association between the markers of mineral and bone disorder (MBD) [calcium (Ca), P, and iPTH] and survival. The Kidney Disease: Improving Global Outcomes (KDIGO) target ranges were included as reference values. Results: Serum P levels >2.49 mmol/l increased the risk of all-cause death [hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.04–2.07; p = 0.030] and cardiovascular death (HR: 2.01; 95%CI: 1.21–3.34; p = 0.007); iPTH levels >600 pg/ml increased the risk of cardiovascular death (HR: 1.95; 95%CI: 1.20–3.15; p = 0.007). Baseline results and TD Cox analyses were similar. All three MBD parameters were within the respective target ranges at least once during the follow-up period in 399 (28.3%) patients, and these patients had better survival rates than those who achieved two of the three target ranges (715/1410 patients; 50.7%); those who achieved one or no target range (296/1410; 21.0%) had the lowest survival rate (all-cause death: log-rank chi square = 83.96, p < 0.001; cardiovascular death: log-rank chi square = 47.06, p < 0.001). Conclusion: Older patients undergoing MHD who achieved the KDIGO target levels for any two or three MBD parameters had lower risks of all-cause and cardiovascular death.

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P1414THE PREDICTORS OF PARATHYROID HORMONE VARIABILITY IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1414 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vasilije Tomanoski ◽

Gordana Gjorgjievska ◽

Vasiliki Krecova ◽

Aleksandar Andonoski ◽

Margarita Nakovska ◽

...

Keyword(s):

Regression Analysis ◽

Amplitude Fluctuation ◽

Target Range ◽

Calcium Balance ◽

Weekly Dose ◽

Chi Square ◽

Number Of Patients ◽

Daily Dose ◽

Low Amplitude ◽

Ca Carbonate

Abstract Background and Aims KDIGO Clinical Practice Guidelines suggest in hemodialysis (HD) patients using a dialysate calcium concentration between 1,25 and 1,5 mmol/L and maintaining serum intact parathyroid hormone (sPTH) levels in the range of approximately 2 to 9 times the upper normal limit for the assay. The aim of the study was to evaluate the predictors of PTH variability in HD patients over a 12 months period. Method The multicenter restrospective study encompassed 398 patients (256M and 142F) with the average age 59,64±13,29 years and the average HD vintage 78,63±64,26 months. Over a 12 months (M0-M12) period: serum calcium (sCa), serum phosphorus (sPi), serum alkaline phosphatase (sAPh), oral calcium-carbonate daily dose, oral calcitriol weekly dose, and dialysate Ca concentration (dCa) were monitored monthly, and sPTH at 6 months. According to PTH assay reference level (18,4-80,1 pg/ml) 3 groups of patients were categorized: patients with low sPTH<160, with target range sPTH =160-721, and with high sPTH>721. For statistical analysis chi-square test, analysis of variance with repeated measures and logistic regression analysis were performed by softver SPSS. Results Over a 12 months period the number of patients with low sPTH significantly decreased, but the number of patients with target range sPTH and high sPTH increased (Chi square=269,45; p<0.001). On the basis of overall pattern of sPTH fluctuation over a 12 months period six subgroups of patients were observed: consistently low in 20,6% of patients, consistently within the target range in 22,1%, consistently high in 14,07%, low-amplitude fluctuation with low and target range sPTH levels (LAL) in 31,4%, low-amplitude fluctuation with target range and high sPTH levels (LAH) in 10,55%, and high-amplitude fluctuation (HA) subgroup with low, target range and high sPTH levels in 1,25%. In 35 patients constantly hemodialyzed over a 12 months period with dCa=1,25 mmol/L due to high sCa the significant increase of sPTH (M0=797±657 vs M12=1030±740 pg/ml; p=0.001) and no significant changes of sCa (M0=2,44± vs M12=2,34± mmol/L; n.s.), sPi (M0=1,81±0,49 vs M12=1,68±0,49 mmol/L; n.s.), Ca-carbonate daily dose (M0=1,88±1,54 vs M12=2,22±1,53 g/d; n.s.) and calcitriol weekly dose (M0=0,84±1,38 vs M12=1,1±1,41 ucg/w; n.s.) were observed. In 24 patients constantly hemodialyzed with dCa=1,75 mmol/L due to low sCa the significant decrease of sPTH (M0=518±582 vs M12=391±530 pg/ml; p=0.037) and no significant changes of sCa (M0=2,17±0,19 vs M12=2,18±0,17 mmol/L; n.s.), sPi (M0=1,3±0,34 vs M12=1,36±0,52 mmol/L; n.s.), Ca-carbonate daily dose (M0=2,53±1,58 vs M12=2,1±1,91 g/d; n.s.) and calcitriol weekly dose (M0=1,33±1,23 vs M12=1,42±1,69 ucg/w; n.s.) were observed. In 195 patients constantly hemodialyzed with dCa=1,5 mmol/L no significant changes of sPTH (M0=388±421 vs M12=434±459 pg/ml; n.s.), sCa (M0=2,29±0,18 vs M12=2,27±0,15 mmol/L; n.s.), sPi (M0=1,48±0,41 vs M12=1,52±0,41 mmol/L; n.s.), Ca-carbonate daily dose (M0=2,42±1,4 vs M12=2,57±1,2 g/d; n.s.) and calcitriol weekly dose (M0=0,47±0,72 vs M12=0,38±0,68 ucg/w; n.s.) were observed. By model of logistic regression analysis dCa=1,75 (OR=8,33), increased sCa (OR=7,7), and presence of diabetes mellitus (OR=2,44) were the most significant predictors of low sPTH<160 (Chi square=116,27; p<0.001), but the increased sCa (OR=6,88), dCa=1,25 (OR=5,08), and the increased sPi (OR=2,72) were the most significant predictors of high sPTH>721 (Chi square=72,475; p<0.001). Conclusion The prolonged use of dCa=1,25 in patients with high sCa led to significant sPTH increase likely due to net negative calcium balance, but prolonged use of dCa=1,75 in patients with low sCa led to significant sPTH decrease likely due to net positive calcium balance.

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Association between Allelic Variations of -174G/C Polymorphism of Interleukin-6 Gene and Chronic Kidney Disease-Mineral and Bone Disorder in Iraqi Patients

Baghdad Science Journal ◽

10.21123/bsj.2020.17.4.1145 ◽

2020 ◽

Vol 17 (4) ◽

pp. 1145

Author(s):

Mohanad Radeef

Keyword(s):

Chronic Kidney Disease ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Vitamin D3 ◽

Interleukin 6 ◽

Maintenance Hemodialysis ◽

Control Group ◽

Significant Elevation ◽

Mineral And Bone Disorder ◽

Hormone Levels

This study designed to examine association between-174G/C polymorphism of interleukin-6 gene and phosphate, calcium, vitamin D3, and parathyroid hormone levels in Iraqi patient with chronic kidney disease on maintenance hemodialysis. Seventy chronic renal failure patients (patients group) and 20 healthy subjects (control group) were genotyped for interleukin-6 polymorphism and genotyping was performed by conventional polymerase chain reaction-restriction fragment length polymorphism. No significant differences in phosphate levels were observed in patients and control with different interleukin-6 genotypes. Control had non-significant differences in calcium levels, while patients with GG and CG genotypes displayed significant elevation with time. Conversely, control and patients with GG and CC genotypes had significant elevation in vitamin D3 levels with time. Regarding parathyroid hormone, control had non-significant differences, while patients with GG and CC genotypes displayed significant elevation with time. Patients with GG genotype displayed significant changes in calcium, vitamin D3 and parathyroid hormone levels with time.

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Heart Rate Variability and Prognosis in Hemodialysis Patients: A Meta-Analysis

Blood Purification ◽

10.1159/000511723 ◽

2020 ◽

pp. 1-11

Author(s):

Letian Yang ◽

Yuliang Zhao ◽

Baiyu Qiao ◽

Yating Wang ◽

Ling Zhang ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Cardiovascular Mortality ◽

Data Extraction ◽

Meta Analysis ◽

Cardiovascular Death ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Cochrane Central Register ◽

Number Of Patients

Background: Heart rate variability (HRV) means the variation in time of beat-to-beat interval. Lower HRV has been shown to be related with death and cardiovascular events in previous studies. In the last few years, the number of patients with ESRD has increased steadily. Maintenance hemodialysis is the most prevalent renal replacement therapy in patients with ESRD. This study aims to investigate if decreased HRV is an independent predictor of mortality in maintenance hemodialysis patients. Methods: Pubmed/Medline, EMBASE, Ovid, the Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched up to October 1, 2019, for full-text articles in English. Cohort studies reporting the association between HRV and prognosis in hemodialysis patients were selected. Data extraction was performed by 2 reviewers independently, with adjudication by a third reviewer. Extracted data included the study characteristics, HRV measurement and research outcomes. Hazard ratios (HRs) and 95% confidence interval (CI) were pooled in a random-effects model for outcomes of all-cause and cardiovascular mortality. Heterogeneity assessment, subgroup analyses, and sensitivity analysis were conducted. Results: A total of 7 studies were eligible. HRV metrics consist of SDNN, SDANN, RMSSD, pNN50, HRVTI, ULF, VLF, LF, HF, LF/HF ratio, HRT, DC, and scaling exponents α1 and α2. Decreased HRV was associated with higher all-cause mortality (HR: 1.63, 95% CI: 1.11–2.39, p = 0.014) and cardiovascular mortality (HR: 1.07, 95% CI: 1.00–1.15, p = 0.045). Among the different HRV metrics, decreased SDANN (p < 0.001) and decreased LF/HF ratio (p = 0.001) were identified as predictors of all-cause death. Decreased SDNN, SDANN, and LF/HF ratio were identified as predictors of cardiovascular death (p = 0.004, p = 0.001, and p = 0.002). Conclusions: Decreased HRV is associated with higher risk of all-cause and cardiovascular death in the hemodialysis population. Decreased SDANN and LF/HF were identified as predictors of both all-cause and cardiovascular mortality, while the utility of other HRV metrics requires further investigation. The protocol for this study was registered with PROSPERO (CRD42019141886).

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P0899BIOMARKERS OF CKD-MBD IN CHILDREN

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0899 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Altynay Balmukhanova ◽

Assiya Kanatbayeva ◽

Kairat Kabulbayev ◽

Abay Shepetov ◽

Aigul Balmukhanova

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Correlation Analysis ◽

Bone Metabolism ◽

Laboratory Tests ◽

Mean Value ◽

Mineral And Bone Disorder ◽

Number Of Patients ◽

Bone Disorder ◽

Fgf 23

Abstract Background and Aims In recent years there has been a growth in the number of patients with chronic kidney disease (CKD). As it is known, one of the most severe complications of CKD is mineral and bone disorder (MBD). MBD, which develops in childhood, contributes not only to the development of degenerative bone disease, but also to the growth of vascular morbidity and mortality in adulthood. Therefore, adequate control of bone and mineral metabolism is one of the goals in the treatment of children with CKD. Due to the recently discovered FGF-23, a significant role in the pathogenesis of MBD is given to hyperphosphatemia as the initiator of the process. However, changes in value of phosphorus and parathyroid hormone (PTH) are revealed only on the last stages of the disease. FGF-23 is a protein, which produced in bone cells and nowadays it is considered to be the central regulator of mineral-bone metabolism. It increases the loss of phosphorus in the urine due to the blockade of the sodium-phosphorus transporter in the proximal tubule of the nephron. FGF-23 also inhibits 1α-hydroxylase and stimulates 24-hydroxylase, leading to accelerated degradation of the active form of vitamin D. Thus, the aim of our study was to investigate the relation between FGF-23 and other markers of bone metabolism such as phosphorus and parathyroid hormone. Method The study was conducted on 73 children (38 boys and 35 girls) with different stages of CKD. An average age of the patients was 9.89 ± 0.57 years. Exclusion criteria: active inflammatory, bone, infectious, oncological, immunological diseases; taking steroids and vitamin D supplements. We performed further laboratory tests: phosphorus, PTH, vitamin D and FGF-23. Serum concentration of intact FGF-23 was assessed by using the kit for ELISA method (Biomedica Medizinprodukte GmbH, Austria). This study was approved by the local scientific ethics committee of National medical university. Ethical standards and rights of patients were not violated. Descriptive statistics and correlation analysis were performed in MS Excel 2016 and SPSS 18.0. Results The laboratory tests results revealed that the mean value of phosphorus was 1.77±0.04 mmol/l among all patients with different stages of CKD. There were 29 (33.3%) children with hyperphosphatemia. The most of these patients were ESRD and they needed a renal replacement therapy. No patients with CKD 1-3 stages had high level of phosphorus. The values of PTH increase as CKD progresses. The patients with the first and second stages had absolutely normal PTH value and only 2 patients with the third stage had slightly elevated level. Only 1 out of 17 patients on dialysis (both hemodialysis and peritoneal dialysis) had an acceptable PTH value. By contrast, there was a vitamin D deficiency (a mean value was 22.4±1.64 ng/ml). The results of identification FGF-23 by the ELISA kit showed that there was also a gradual increase in its level depending on the stage of the disease. Moreover, there were 14 (19.2%) children with elevated FGF-23 concentration though other markers of bone metabolism were normal. The correlation analysis revealed positively significant associations between FGF-23 and phosphorus (r=0.60, p=0.00), FGF-23 and PTH (r=0.68, p=0.00). Conclusion Overall, our investigation proved that FGF-23 is positively correlated to phosphorus and PTH. Furthermore, in most cases, FGF-23 responds much sooner than other markers of mineral and bone metabolism and its increased value might be an early predictor of mineral and bone disorder. However, more research is required in this area.

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To Study the Association of Parathyroid Hormone with Severe Anaemia in Chronic Renal Failure Patients

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/155 ◽

2021 ◽

Vol 10 (10) ◽

pp. 724-728

Author(s):

Madhavi Sarkari ◽

Mahim Mittal ◽

Ashutosh Kumar Rai

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Parathyroid Hormone ◽

Chronic Renal Failure ◽

Kidney Disease ◽

Secondary Hyperparathyroidism ◽

Clinical History ◽

Intact Parathyroid Hormone ◽

Mineral And Bone Disorder ◽

Cross Sectional

BACKGROUND Chronic kidney disease is defined as abnormalities of kidney structure or function, present for > 3 months, with implications for health. In India, the prevalence of chronic kidney disease (CKD), ranges from 0.79 % to 1.4 %. Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anaemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anaemia, and correlation of intact parathyroid hormone (iPTH) and haemoglobin (Hb) levels in chronic renal failure (CRF) patients on haemodialysis and also in CRF patients who are not on haemodialysis. METHODS This is an observational cross-sectional study done in the department of medicine in BRD Medical College, Gorakhpur, Uttar Pradesh, India, over a period of one year among a total of 101 patients. All patients underwent detailed clinical history, clinical examination & relevant biochemical investigations. RESULTS Parathyroid hormone level was found elevated in 82.2 % CRF patients in our study; out of these 76.2 % patients were severely anaemic. CONCLUSIONS Anaemia mainly normocytic & normochromic is a common complication of chronic kidney disease. Hormonal failure in CRF patients is very commonly reflected as anaemia & mineral and bone disorder (CKD-MBD). Parathyroid hormone was found elevated in most (82.2 %) of the CRF patients with anaemia. KEY WORDS Chronic Renal Failure (CRF), Intact Parathyroid Hormone (iPTH), Secondary Hyperparathyroidism (SHPT), Chronic Kidney Disease (CKD)

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Frequency of anemia in patients with increased level of parathyroid hormone among patients on maintenance hemodialysis.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.06.4272 ◽

2020 ◽

Vol 27 (06) ◽

pp. 1255-1258

Author(s):

Saad Muzaffar Azeem ◽

Anita Haroon ◽

Ishtiaque Alam ◽

Sadia Azeem ◽

Mahrukh Sultana ◽

...

Keyword(s):

Parathyroid Hormone ◽

Renal Disease ◽

End Stage Renal Disease ◽

Maintenance Hemodialysis ◽

Cross Sectional ◽

Number Of Patients ◽

Study Results ◽

The Mean ◽

Stage Renal Disease ◽

End Stage

Objectives: One of the most frequently occurring complication of end stage renal disease is anemia. It can be defined as decrease in red blood cells with hemoglobin concentration less than 12 g/dl in women and less than 13 g/dl in men. Parathyroid hormone levels are also raised among patients with end stage renal disease to maintain serum calcium levels. The objective of this study is to evaluate the degree of anemia in patients with end stage renal disease currently on maintenance hemodialysis and have raised PTH levels. Study Design: Cross-sectional study. Setting: Kidney Center, Karachi. Period: November 2015 to July 2016. Material & Method: Patients undergoing maintenance hemodialysis during the study duration with PTH levels greater than 300 ng/L were included in the study. Patients with other co-morbid conditions like chronic liver disease and hypersplenism were excluded from the study. Results: The total number of patients on maintenance hemodialysis in the kidney center that matched our inclusion criteria was 110. Amongst them there were 47.3% (n=52) males and 52.7% (n=58) females. The mean age of patients in our study is 50.15 ± 12.92 years. The mean PTH level of patients was found to be 642 ± 405.9U. Since all the participants of the study are on maintenance dialysis, the mean duration of hemodialysis was found to be 4.2 ± 3.19 months. The mean hemoglobin level of patients was found to be 9.75 ± 1.47 g/dl. Conclusion: Patients with hyperparathyroidism and undergoing maintenance hemodialysis frequently develops anemia. Many factors account for this including raised PTH levels causing bone marrow fibrosis, decreased production of erythropoietin and resistance of produced erythropoietin are some factors responsible for the anemia.

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Changes in 3-month mineral and bone disorder patterns were associated with all-cause mortality in prevalent hemodialysis patients with secondary hyperparathyroidism

10.21203/rs.3.rs-16245/v2 ◽

2020 ◽

Author(s):

Chihiro Kato ◽

Naohiko Fujii ◽

Chisato Miyakoshi ◽

Shinji Asada ◽

Yoshihiro Onishi ◽

...

Keyword(s):

Parathyroid Hormone ◽

Secondary Hyperparathyroidism ◽

Hemodialysis Patients ◽

Lower Mortality ◽

Intact Parathyroid Hormone ◽

Mineral And Bone Disorder ◽

High Category ◽

Bone Disorder ◽

All Cause Mortality ◽

Changing Patterns

Abstract Background. There is limited evidence on the association between short-term changes in mineral and bone disorder parameters and survival in maintenance hemodialysis patients. Methods. We investigated the association between changing patterns of phosphorus, calcium and intact parathyroid hormone levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism. Each parameter was divided into three categories (low [L], middle [M] and high [H]), and the changing patterns between two consecutive visits at 3-month intervals were categorized into nine groups (e.g., L-L and M-H). The middle category was defined as 4.0-7.0 mg/dL for phosphorous, 8.5-9.5 mg/dL for calcium and 200-500 pg/mL for intact parathyroid hormone. Adjusted incidence rates and rate ratios were analyzed by weighted Poisson regression models accounting for time-dependent exposures. Results. For phosphorus, shifts from low/high to middle category (L-M/H-M) were associated with a lower mortality compared with the L-L and H-H groups, whereas shifts from middle to low/high category (M-L/M-H) were associated with a higher mortality compared with the M-M group. For calcium, shifts from low/middle to high category (L-H/M-H) were associated with a higher mortality compared with the L-L and M-M groups, whereas shifts from high to middle category (H-M) were associated with a lower mortality compared with the H-H group. For intact parathyroid hormone, shifts from low to middle category (L-M) were associated with a lower mortality compared with the L-L group. Conclusions. Changes in the 3-month patterns of phosphorus and calcium toward the middle category were associated with lower mortality. Our study also suggests the importance of avoiding hypercalcemia.

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Osteopontin Levels in Patients With Chronic Kidney Disease Stage 5 on Hemodialysis Directly Correlate With Intact Parathyroid Hormone and Alkaline Phosphatase

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619896621 ◽

2019 ◽

Vol 25 ◽

pp. 107602961989662

Author(s):

Aleksander Druck ◽

Dimpi Patel ◽

Vinod Bansal ◽

Debra Hoppensteadt ◽

Jawed Fareed

Keyword(s):

Chronic Kidney Disease ◽

Alkaline Phosphatase ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Confidence Interval ◽

Mineral Metabolism ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Maintenance Hemodialysis ◽

Intact Parathyroid Hormone

Chronic kidney disease stage 5 (CKD5) marks the fifth stage of renal failure, frequently causing dysregulation of bone and mineral metabolism. Challenges exist in evaluating and managing chronic kidney disease–mineral bone disorder (CKD-MBD) with the standard panel of biomarkers. Our objective was to profile osteopontin (OPN) in patients with CKD5 on maintenance hemodialysis (CKD5-HD) and elucidate its relationship to phosphorus (P), calcium (Ca2+), alkaline phosphatase (AP), and intact parathyroid hormone (iPTH) to improve understanding of the present model of CKD-MBD. Elevation of plasma OPN was seen in the CKD5-HD cohort (n = 92; median: 240.25 ng/mL, interquartile range [IQR]: 169.85 ng/mL) compared to a normal group (n = 49; median: 63.30 ng/mL, IQR: 19.20 ng/mL; p < .0001). Spearman correlation tests revealed significant positive correlations of OPN with iPTH ( p < .0001; r = 0.561, 95% confidence interval = 0.397-0.690) and OPN with AP ( p < .0001; r = 0.444, 95% confidence interval = 0.245-0.590) in CKD5-HD patients. Ultimately, OPN may play an integral role in the MBD axis, suggesting that it may be important to actively monitor OPN when managing CKD5-HD.

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Changes in 3-month mineral and bone disorder patterns were associated with all-cause mortality in prevalent hemodialysis patients with secondary hyperparathyroidism

BMC Nephrology ◽

10.1186/s12882-020-02088-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Chihiro Kato ◽

Naohiko Fujii ◽

Chisato Miyakoshi ◽

Shinji Asada ◽

Yoshihiro Onishi ◽

...

Keyword(s):

Parathyroid Hormone ◽

Secondary Hyperparathyroidism ◽

Hemodialysis Patients ◽

Lower Mortality ◽

Intact Parathyroid Hormone ◽

Mineral And Bone Disorder ◽

High Category ◽

Bone Disorder ◽

All Cause Mortality ◽

Changing Patterns

Abstract Background There is limited evidence on the association between short-term changes in mineral and bone disorder parameters and survival in maintenance hemodialysis patients. Methods We investigated the association between changing patterns of phosphorus, calcium and intact parathyroid hormone levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism. Each parameter was divided into three categories (low [L], middle [M] and high [H]), and the changing patterns between two consecutive visits at 3-month intervals were categorized into nine groups (e.g., L-L and M-H). The middle category was defined as 4.0–7.0 mg/dL for phosphorous, 8.5–9.5 mg/dL for calcium and 200–500 pg/mL for intact parathyroid hormone. Adjusted incidence rates and rate ratios were analyzed by weighted Poisson regression models accounting for time-dependent exposures. Results For phosphorus, shifts from low/high to middle category (L-M/H-M) were associated with a lower mortality compared with the L-L and H–H groups, whereas shifts from middle to low/high category (M-L/M-H) were associated with a higher mortality compared with the M-M group. For calcium, shifts from low/middle to high category (L–H/M-H) were associated with a higher mortality compared with the L-L and M-M groups, whereas shifts from high to middle category (H-M) were associated with a lower mortality compared with the H–H group. For intact parathyroid hormone, shifts from low to middle category (L-M) were associated with a lower mortality compared with the L-L group. Conclusions Changes in the 3-month patterns of phosphorus and calcium toward the middle category were associated with lower mortality. Our study also suggests the importance of avoiding hypercalcemia.

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Survival of Patients on Maintenance Hemodialysis Base on Comorbidity of Cardiovascular Disease in Persahabatan Central General Hospital 2015-2019

JURNAL INFO KESEHATAN ◽

10.31965/infokes.vol19.iss2.547 ◽

2021 ◽

Vol 19 (2) ◽

pp. 125-133

Author(s):

Mila Fitriaty ◽

Nurhayati Adnan ◽

Muhammad Syafiq

Keyword(s):

Diabetes Mellitus ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Internal Validity ◽

Secondary Data ◽

Maintenance Hemodialysis ◽

P Value ◽

Risk Of Death ◽

Number Of Patients

Chronic kidney disease is the progressive loss of kidney function over months or years. The significant increase in new cases of chronic kidney disease is in line with the increasing number of patients undergoing hemodialysis as kidney replacement therapy in an effort to survive. Comorbid cardiovascular disease is a major risk factor for morbidity and mortality with chronic kidney disease. The study was conducted to determine the survival of hemodialysis patients in the group with comorbid cardiovascular disease and the group without comorbid cardiovascular disease. This study used a retrospective cohort design. The location of this study was conducted at Persahabatan Central Public Hospital, DKI Jakarta, and used secondary data from the hospital information system data from 2015 to 2019. The variables significantly related to the survival of patients undergoing hemodialysis with comorbid cardiovascular disease were age, complications of anemia, diabetes mellitus, and hypertension. The age variable has a p-value of 0.029 with an HR of 1.54 (95% CI OR 1.043-2.262). The anemia variable has a p-value of 0.013 with an HR of 1.60 (95% CI 1.117-2.515). The diabetes mellitus variable has a p-value of 0.000 with HR2.71 (95% CI 1.780-4.11). The hypertension variable has a p-value of 0.004 with HR1.79 (95% CI 1.208-2.646). In conclusion, patients undergoing hemodialysis with comorbid cardiovascular disease have a risk of death of 0.76 times compared to patients undergoing hemodialysis with the comorbid non-cardiovascular disease. This study's internal validity was not good due to selection bias and non-differential misclassification information bias. Thus, the results of this study cannot be generalized.

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