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Abstract: FR-PO465

Association Between Calcium, Phosphate, Intact Parathyroid Hormone Levels, and Mortality Among Patients on Peritoneal Dialysis

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Murashima, Miho, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Hamano, Takayuki, Nagoya Shiritsu Daigaku, Nagoya, Aichi, Japan
  • Goto, Shunsuke, Kobe Daigaku, Kobe, Hyogo, Japan
  • Hasegawa, Takeshi, Showa Daigaku, Shinagawa-ku, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai Daigaku, Hiratsuka, Kanagawa, Japan
  • Abe, Masanori, Nihon Daigaku, Chiyoda-ku, Tokyo, Japan
  • Hanafusa, Norio, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
Background

Association between calcium, phosphate, intact parathyroid hormone (PTH) levels and mortality has been extensively studied among patients on hemodialysis. However, studies limited to patients on peritoneal dialysis (PD) are lacking.

Methods

This is a prospective cohort study on Japan Renal Data Registry. Adults on PD at the end of 2009 were included. The observation period was up to 9 years and data were censored at the time of transplantation or transition to hemodialysis. Exposures were time-averaged albumin-corrected calcium (cCa), phosphate, and intact PTH levels. Outcomes were all-cause and cardiovascular (CV) mortality. Data were analyzed using Cox regression models and the results were shown as cubic spline curves.

Results

Among 2,017 patients with data for analyses, the mean age was 62 (14) years, 67 % were male, and the median PD vintage was 2.3 (1.0-4.3) years. During a median follow-up of 3.0 years, 590 death and 211 CV death (62 atherosclerotic and 149 non-atherosclerotic) were observed. Higher time-averaged cCa levels tended to be associated with higher mortality. Lower time-averaged phosphate levels were associated with lower all-cause mortality. No significant association between intact PTH levels and all-cause mortality was observed. The association between time-averaged cCa and CV mortality was U-shaped. Higher phosphate levels were associated with death due to atherosclerotic CV diseases but not with death due to non-atherosclerotic CV diseases. Sensitivity analyses by time-dependent model yielded similar results.

Conclusion

Among PD patients, higher cCa levels tended to be associated with higher all-cause mortality, and the relation between cCa levels and CV mortality was U-shaped. Lower phosphate levels were associated with lower all-cause mortality. Targeting cCa toward normal levels and phosphate levels toward the lower limit of normal range seems to be reasonable. Control of intact PTH might be of less importance among PD patients.