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Association between CKD-MBD and mortality in older patients with advanced CKD-results from the EQUAL study
Lorenza Magagnoli1,2, Mario Cozzolino1,2, Fergus J Caskey3,4
1University of Milan, Department of Health Sciences, Milan, Italy.
Insights
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is common in older CKD patients. Parathyroid hormone (PTH) and phosphate levels independently predict all-cause mortality, with phosphate also linked to cardiovascular and non-cardiovascular death.
Area of Science:
- Nephrology
- Endocrinology
- Geriatrics
Background:
- Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a frequent complication in chronic kidney disease (CKD).
- While CKD-MBD is linked to increased mortality in dialysis patients, its impact on non-dialysis patients is less understood.
- This study focuses on older non-dialysis patients with advanced CKD.
Purpose of the Study:
- To investigate the associations between parathyroid hormone (PTH), phosphate, and calcium levels (and their interactions) with mortality in older non-dialysis CKD patients.
- To differentiate the impact of these biomarkers on all-cause, cardiovascular (CV), and non-CV mortality.
Main Methods:
- Utilized data from the European Quality study, including patients aged ≥65 years with estimated glomerular filtration rate ≤20 mL/min/1.73 m2.
- Employed sequentially adjusted Cox models to analyze baseline and time-dependent CKD-MBD biomarkers and mortality outcomes.
- Assessed potential effect modification between different biomarkers.
Main Results:
- CKD-MBD prevalence was 94% at baseline in 1294 patients.
- Elevated PTH (aHR 1.12) and phosphate (aHR 1.35) were independently associated with all-cause mortality; calcium was not.
- Phosphate, but not PTH, showed an interaction with calcium, increasing mortality risk in hypercalcemia and hyperphosphatemia. PTH was linked to CV mortality, while phosphate was associated with both CV and non-CV mortality.
Conclusions:
- CKD-MBD is highly prevalent in older, non-dialysis patients with advanced CKD.
- Parathyroid hormone (PTH) and phosphate are significant independent predictors of all-cause mortality in this population.
- Phosphate is associated with both cardiovascular and non-cardiovascular mortality, whereas PTH is primarily linked to cardiovascular mortality.
Background:
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication of CKD; it is associated with higher mortality in dialysis patients, while its impact in non-dialysis patients remains mostly unknown. We investigated the associations between parathyroid hormone (PTH), phosphate and calcium (and their interactions), and all-cause, cardiovascular (CV) and non-CV mortality in older non-dialysis patients with advanced CKD.
Methods:
We used data from the European Quality study, which includes patients aged ≥65 years with estimated glomerular filtration rate ≤20 mL/min/1.73 m2 from six European countries. Sequentially adjusted Cox models were used to assess the association between baseline and time-dependent CKD-MBD biomarkers and all-cause, CV and non-CV mortality. Effect modification between biomarkers was also assessed.
Results:
In 1294 patients, the prevalence of CKD-MBD at baseline was 94%. Both PTH [adjusted hazard ratio (aHR) 1.12, 95% confidence interval (CI) 1.03-1.23, P = .01] and phosphate (aHR 1.35, 95% CI 1.00-1.84, P = .05), but not calcium (aHR 1.11, 95% CI 0.57-2.17, P = .76), were associated with all-cause mortality. Calcium was not independently associated with mortality, but modified the effect of phosphate, with the highest mortality risk found in patients with both hypercalcemia and hyperphosphatemia. PTH level was associated with CV mortality, but not with non-CV mortality, whereas phosphate was associated with both CV and non-CV mortality in most models.
Conclusions:
CKD-MBD is very common in older non-dialysis patients with advanced CKD. PTH and phosphate are independently associated with all-cause mortality in this population. While PTH level is only associated with CV mortality, phosphate seems to be associated with both CV and non-CV mortality.
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