Kidney Week

Abstract: TH-OR17

Secondary Hyperparathyroidism Is Associated with Weight Loss and Longer-Term Mortality Among Patients Undergoing Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study

Session Information

• Novel Approaches to Mineral and Bone Metabolism
  October 22, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Komaba, Hirotaka, Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan

Hirotaka Komaba, MD, PhD



Hirotaka Komaba is Associate Professor of the Division of Nephrology, Endocrinology and Metabolism at Tokai University School of Medicine. He received his MD from Kobe University School of Medicine and completed his PhD at Kobe University Graduate School of Medicine. Following a transfer to Tokai University School of Medicine, he completed his postdoctoral research at Harvard School of Dental Medicine. His primary research interest is in the area of disordered mineral metabolism in kidney disease, with special focus on the role of PTH, FGF23, and Klotho. He has authored over 100 peer-reviewed publications including in KI, CJASN, AJKD, NDT, JCEM, Nature Reviews Nephrology, and Cell Metabolism.

• Zhao, Junhui, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Junhui Zhao,

• Yamamoto, Suguru, Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Suguru Yamamoto,

• Nomura, Takanobu, Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan

Takanobu Nomura,

• Fuller, Douglas S., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Douglas S. Fuller,

• McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Keith McCullough,

• Evenepoel, Pieter, Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium

Pieter Evenepoel,

• Christensson, Anders, Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden

Anders Christensson,

• Zhao, Xinju, Department of Nephrology, Peking University People’s Hospital, Beijing, China

Xinju Zhao,

• Al Rukhaimi, Mona, Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates

Mona Al Rukhaimi,

• Al-Ali, Fadwa M., Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

Fadwa M. Al-Ali,

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

Eric W. Young,

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

Bruce M. Robinson,

• Fukagawa, Masafumi, Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan

Masafumi Fukagawa,

Background

Wasting is a common complication of kidney failure that leads to weight loss and poor outcomes. Recent experimental data identified parathyroid hormone (PTH) as a driver of adipose tissue browning and wasting, but little is known about the relations among secondary hyperparathyroidism (SHPT), weight loss, and risk of mortality in patients undergoing hemodialysis.

Methods

We included 42,319 participants receiving hemodialysis for at least one year in the DOPPS phases 2-6 (2002-2018). Linear mixed models were used to estimate the association between baseline PTH and percent weight change over 12 months, adjusting for country, demographics, comorbidities, and labs. Accelerated failure time models were used to assess 12-month weight loss as a mediator between baseline high PTH and mortality after 12 months.

Results

At baseline, mean (SD) body weight was 74 (22) kg and the median PTH level was 251 pg/mL (interquartile range [IQR], 131-444 pg/mL). Baseline PTH was inversely associated with 12-month weight change: 12-month weight loss >5% was observed in 21%, 18%, 18%, 17%, 16%, and 14% of patients for PTH ≥600 pg/mL, 450-600, 300-450, 150-300, 50-150, and <50 pg/mL, respectively. In adjusted analysis, 12-month weight change compared to PTH 150-299 pg/mL was -0.60%, -0.12%, -0.10%, +0.15%, and +0.35% for PTH ≥600, 450-600, 300-450, 50-150, and <50 pg/mL, respectively (P<0.01). Interacting baseline PTH*appetite, high PTH was associated with weight loss only in persons with preserved appetite (P<0.01). During follow-up after the 12-month weight measure (median, 1.0 [IQR, 0.6-1.7] years; 6125 deaths), patients with baseline PTH ≥600 pg/mL had 11% (95% CI, 9-13%) shorter lifespan, and 18% (95% CI,14-23%) of this effect was mediated through weight loss ≥2.5%.

Conclusion

Our findings indicate that SHPT may be a novel mechanism of wasting in dialysis patients, corroborating experimental data, and that this pathway may be a mediator between elevated PTH levels and mortality. Future research should determine whether PTH-lowering therapy can limit or prevent weight loss and improve longer-term dialysis outcomes.

Funding

• Commercial Support –