Kidney Week

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

• Bone and Mineral Metabolism: Phosphorus, FGF23, Vascular Calcification
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Young, Eric W., Arbor Research, Ann Arbor, Michigan, United States

Eric W. Young,

• Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Angelo Karaboyas,

• Csomor, Philipp, Vifor Fresenius Medical Care Renal Pharma Ltd., Glattbrugg, Switzerland

Philipp Csomor,

• Spiegel, David M., Relypsa, Inc. , Denver, Colorado, United States

David M. Spiegel,

• Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Kanagawa, Japan

Masafumi Fukagawa,

• Al Salmi, Issa, The Royal Hospital, Muscat, Oman

Issa Al Salmi,

• Evenepoel, Pieter, University Hospitals Leuven, Leuven, Belgium

Pieter Evenepoel,

• Jacobson, Stefan H., Danderyd Hospital, Stockholm, Sweden

Stefan H. Jacobson,

• Liang, Xinling, Guangdong Provincial People''s Hospital, Guangzhou, GUANGDONG, China

Xinling Liang,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

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 – This analysis was supported by Vifor. The DOPPS Program is supported by Amgen (since 1996, founding sponsor), Kyowa Hakko Kirin (since 1999 for Japan DOPPS), and Baxter Healthcare Corp. Additional support for specific projects and countries is provided by Akebia Therapeutics, AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fibrogen, Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Italian Society of Nephrology (SIN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Otsuka America, Proteon Therapeutics, the Association of German Nephrology Centres, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Belgian Federal Public Service of Public Health in Belgium, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN), and Kidney Research UK (KRUK) in the United Kingdom, and the Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health.