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Abstract: TH-PO210

Combined Impact of Phosphorous and Calcium on Mortality Risk in 109,205 Hemodialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Aguirre, Antonio, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Kleine, Carola-Ellen, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
Background

Mineral and bone disorder (MBD) is highly prevalent in patients with chronic kidney disease (CKD). Serum phosphorus (Phos), calcium (Ca) and calcium phosphorus product have been shown to be independently associated with mortality risk in hemodialysis patients. We sought to examine whether evaluating the combination of Phos and Ca can better predict mortality rates among dialysis patients.

Methods

Our analytical cohort consists of 109,205 incident hemodialysis patients receiving treatment from a large dialysis organization between 2007 and 2011. Associations between combined serum Phos and Ca values for the first dialysis quarter (dialysis start + 91 days) and mortality were estimated using Cox proportional hazard models with adjustment for demographics and markers of malnutrition and inflammation.

Results

Mean patient age was 63 ±15 years, while 44% were female, 32% were African American, and 58% were diabetic. The mean amount of Phos in the total cohort was 4.9 ± 1.1 mg/dL and the mean amount for Ca was 9.1 ± 0.6 mg/dL. Compared to the reference group (Phos ≥10.2 mg/dL and Ca ≥7 mg/dL), all-cause mortality tended to be lowest in patients with Phos 3.5-<5.5 mg/dL and Ca 8.4-<9.5 mg/dL (Hazard Ratio 0.60, 95% CI 0.44, 0.82). Besides, patients in the highest Phos group (≥ 7mg/dL) had the highest mortality risk across all strata of serum Ca. (Figure 1)

Conclusion

In hemodialysis patients, keeping serum Phos and Ca within or close to the physiological range might result in better survival. Further studies are needed to examine this association.

Funding

  • NIDDK Support