Abstract: FR-PO887

Mineral Bone Disorder Management in Hemodialysis Patients: Comparing PTH Control Practices in Japan with Europe and North America: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Yamamoto, Suguru, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Komaba, Hirotaka, Tokai University School of Medicine, Isehara, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukukoka, Japan
  • Nomura, Takanobu, Kyowa Hakko Kirin Co Ltd, Tokyo, Japan
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • De Sequera, Patricia, University Hospital Infanta Leonor, Madrid, Spain
  • Christensson, Anders, Skåne University Hospital, Malmö, Sweden
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

High circulating level of parathyroid hormone (PTH) is associated with elevated mortality. While the Japanese Society for Dialysis Therapy suggests a low/narrow PTH target, other international guidelines suggest much higher PTH targets. This discrepancy may help explain better survival in Japanense hemodialysis patients, and we analyzed PTH control practices in Japan compared with other regions.

Methods

We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months in DOPPS phase 4 and 5 (2009-2015). PTH control was defined by slope of log (PTH), parameterized as % change per month, and PTH mean was defined by the geometric mean of all measurements over the 9 month run-in period. Distribution of PTH slopes and means were assessed by regions [Europe/Australia/New Zealand (Eur-ANZ), Japan and North America] and dialysis vintage (<90 days, 90 days-1 year and >1 year). Mortality rates were compared across PTH slope and mean using Cox regression models.

Results

Our sample included 6035 patients in Eur-ANZ, 2644 in Japan and 18485 in North America. Mean PTH was much lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage <90 days, PTH level was more likely to decline >5% per month in Japan (49% of patients) vs. Eur-ANZ (34%) and North America(32%). In patients with dialysis vintage >1 year, Japanese patients were most likely to maintain steady PTH (ΔPTH within +/-5% per month: 47% in Japan vs 41% in Eur-ANZ and 41% in North America), with patients in Eur-ANZ and North America more likely to experience increase in PTH. During 13.5 (IQR, 5.9-22.9) months follow-up, prevalent patients with the highest mean PTH (>600 pg/mL) had the highest mortality rate [HR=1.22 (95% CI 1.02-1.47) vs. PTH 200-400 pg/mL]. PTH slope was not clearly associated with all-cause mortality.

Conclusion

PTH control, as measured by keeping a stable PTH level over 9 months, is better in Japan vs. other regions. No additional survival benefit for PTH control was observed, further study is needed to understand the reasons of keeping low PTH levels and its impact on survival advantage in Japan.

Funding

  • Commercial Support