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Kidney Week

Abstract: PO0366

Low Phosphate and Low Calcium Levels Predict Higher Risk for Adverse Events of Maintenance Hemodialysis

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Kuragano, Takahiro, Hyogo College of Medicine Kidney and dialysis, Nisinomiya, Japan
  • Nakanishi, Takeshi, Hyogo College of Medicine Kidney and dialysis, Nisinomiya, Japan
Background

It is well known higher serum levels of phosphate (P) and calcium (Ca) associated with higher risk of cardiovascular disease (CVD) and premature death of hemodialysis (HD) patients. However, in the current situation that guidelines penetrated widely, there are few reports which investigated the association CKD-MBD related factors and adverse events of HD patients.

Methods

The study design was the multiple centers, observational study for 3yeras. 989 HD patients were enrolled in this study. Hb, ferritin, creatinine, total protein, albumin, total cholesterol, Ca and P levels were measured every 3 months. Hhigh-sensitivity C-reactive protein (hCRP) and intact-parathyroid hormone (int-PTH) were also measured every six months. The correlation between CKD-MBD factors and adverse events were evaluated by the time depended cox hazard model.

Results

82% (P), 83% (Ca), and 78% (int-PTH) of patients were maintained in a target range. After correlated with age, sex, past history of CVD, Hb, albumin, and hCRP, compared with the patients with target levels of P, patients with low P levels were significantly higher risk for CVD (P=0.042, HR:2.27), hospitalization (P=0.034, HR:2.44), and all caused mortality (P=0.03, HR:2.29). Compared with the patients who maintain target int-PTH levels, patients with lower (P=0.025, HR:1.46) and higher (P=0.04, HR:1.44) int-PTH were significantly higher risk for hospitalization. Furthermore, compared with the patients who maintain the target levels both of Ca and P, the patients with target Ca and low P levels (P=0.042, HR: 2.75) were significantly higher risk for CVD. And compared with the patients who maintain the target levels both of Ca and P, the patients with low Ca and low P levels (P<0.001, HR: 4.4) and target Ca and low P levels (P=0.22, HR: 2.0) were significantly higher risk for hospitalization.

Conclusion

Although after corelated by several clinical factors, we found that patients who maintain the low serum P levels beard significantly higher risk for CVD and all caused mortality than patients who maintained higher Ca and P levels. Without doubt, extremely higher serum P, Ca, and int-PTH levels should be treated according to guidelines. However, in the current situation that guidelines penetrated widely, CKD-MBD managements which considered the clinical conditions of low P, Ca, and int-PTH are needed.