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Cardiovascular mortality in peritoneal dialysis: the impact of mineral disorders

César Truyts1, Melani Custodio1, Roberto Pecoit-Filho2

  • 1Universidade de São Paulo, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil.

Jornal Brasileiro De Nefrologia
|February 12, 2021
PubMed

Insights

High phosphorus and low parathyroid hormone levels are linked to cardiovascular death in peritoneal dialysis patients. These findings highlight the importance of monitoring these mineral and bone disorder markers in PD patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Mineral and Bone Disorders

Background:

  • Mineral and bone disorders (MBD) increase mortality risk in dialysis patients.
  • Current guidelines (KDOQI, KDIGO) for MBD are primarily based on hemodialysis data.
  • The impact of MBD on peritoneal dialysis (PD) patients requires further investigation.

Purpose of the Study:

  • To assess the association between serum calcium, phosphorus, and parathyroid hormone levels and cardiovascular mortality in PD patients.
  • To evaluate these associations in the context of KDOQI and KDIGO guideline ranges.
  • To provide insights into MBD management for PD populations.

Main Methods:

  • Utilized the BRAZPDII prospective observational database (2004-2011).
  • Analyzed data from 4424 participants on PD for at least 6 months.
  • Included serum calcium, phosphorus, and parathyroid hormone levels as key variables, adjusting for confounders.

Main Results:

  • Elevated serum phosphorus levels (above 5.5 mg/dL) were significantly associated with increased cardiovascular mortality (p < 0.01).
  • Lower serum parathyroid hormone levels (below 150 pg/mL) were significantly associated with increased cardiovascular mortality (p < 0.01).
  • These associations were observed within the ranges defined by KDOQI and KDIGO guidelines.

Conclusions:

  • Serum phosphorus levels above KDOQI/KDIGO recommendations are linked to higher cardiovascular mortality in PD patients.
  • Serum parathyroid hormone levels below KDOQI/KDIGO recommendations are linked to higher cardiovascular mortality in PD patients.
  • Current MBD guidelines may be relevant for optimizing cardiovascular outcomes in PD patients.
Abstract

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