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Abstract: FR-PO128

PTH Levels Prior to Initiating Hemodialysis: Associations with Prescription of PTH-Lowering Therapies and Risk of Uncontrolled PTH During the First Year of Hemodialysis

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Young, Eric W., Arbor Research, Ann Arbor, Michigan, United States
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Csomor, Philipp, Vifor Fresenius Medical Care Renal Pharma Ltd., Glattbrugg, Switzerland
  • Spiegel, David M., Relypsa, Inc. , Denver, Colorado, United States
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • Al Salmi, Issa, The Royal Hospital, Muscat, Oman
  • Evenepoel, Pieter, University Hospitals Leuven, Leuven, Belgium
  • Jacobson, Stefan H., Danderyd Hospital, Stockholm, Sweden
  • Liang, Xinling, Guangdong Provincial People''s Hospital, Guangzhou, GUANGDONG, China
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

PTH levels during pre-dialysis may influence subsequent management and achieved PTH levels after onset of ESRD.

Methods

We studied 5683 incident HD patients from 21 countries in phases 4-6 (2009-2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS) with information on PTH measured immediately prior to HD initiation. We stratified by PTH prior to HD start and reported the monthly prescription prevalence of active vitamin D and calcimimetics over the first year of HD, and risk of PTH >600 pg/mL after 9 months on HD.

Results

Median (IQR) PTH prior to HD start was 275 (155, 472) pg/mL and 16% of patients initiated HD with PTH >600 pg/mL. Patients who initiated HD with higher PTH levels were more likely to be prescribed active vitamin D in the early months of HD, and these differences were steady over the first year of HD (Figure A). Patients starting HD with PTH >600 pg/mL were much more likely to initiate calcimimetic treatment during the first year of HD, amplifying differences in calcimimetic use by PTH at HD start over the first year of HD (Figure B). Among a subset of 2728 patients who remained in DOPPS with PTH measured 9-12 months after HD initiation, the prevalence of PTH >600 pg/mL was much greater for patients who initiated HD with PTH >600 (29%) vs. 150-300 (7%) pg/mL.

Conclusion

The findings were consistent with the hypothesis that management of PTH in the pre-ESRD phase influences subsequent PTH management and levels after onset of ESRD. Patients with greater PTH concentrations prior to start of dialysis were more likely to receive active vitamin D and calcimimetic therapy in the first year of HD. However, despite more aggressive management, high PTH prior to initiation of dialysis was associated with high PTH (>600 pg/ml) 9 months after the start of hemodialysis. These findings help inform clinical management and research goals and provide insight into cost drivers for PTH management in HD.

Funding

  • NIDDK Support