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Abstract: TH-PO161

International Variations in Serum PTH and Calcium Levels and Their Mortality Associations in Peritoneal Dialysis Patients: Results from PDOPPS

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Shinjuku-ku, Tokyo, Japan
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Kanjanabuch, Talerngsak, Chulalongkorn University, Bangkok, Bangkok, Thailand
  • Kim, Yong-Lim, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)
  • Lambie, Mark, Keele University, Keele, Staffordshire, United Kingdom
  • Shen, Jenny I., The Lundquist Institute, Torrance, California, United States
  • Naljayan, Mihran V., DaVita Inc, Denver, Colorado, United States
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Perl, Jeffrey, University of Toronto, Toronto, Ontario, Canada
  • Kawanishi, Hideki, Tsuchiya Sogo Byoin, Hiroshima, Japan
Background

Mineral bone disorder (MBD) in chronic kidney disease (CKD) is associated with high symptom burden, fractures, vascular calcification, cardiovascular disease, and increased morbidity and mortality. CKD-MBD studies have been limited in peritoneal dialysis (PD) patients. Here, we describe calcium and parathyroid hormone (PTH) control, and mortality associations in PD patients.

Methods

We used data from 8 countries [Australia and New Zealand (A/NZ), Canada, Japan, Thailand, South Korea, United Kingdom, United States (US)] participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS; 2014-2022) among patients receiving PD for >3 months. We analyzed the association of baseline PTH and albumin-adjusted calcium (calciumAlb) with all-cause mortality using Cox regression, adjusted for potential confounders.

Results

Mean age ranged from 54.6 yrs in South Korea to 63.5 yrs in Japan. PTH and serum calciumAlb were measured at baseline in 12,642 and 14,244 patients, respectively. Median PTH ranged from 161 (Japan) to 363 pg/mL (US); mean calciumAlb ranged from 9.1 (South Korea, US) to 9.8 mg/dL (A/NZ). The PTH/mortality relationship was U-shaped with lowest risk at PTH 300-599 pg/mL. Mortality was nearly 20% higher at serum calciumAlb 9.6+ mg/dL vs 8.4-<9.6 mg/dL.

Conclusion

A large proportion of PD patients in this multi-national study have Ca and/or PTH levels in ranges associated with substantially higher mortality. These observations point to the need to substantially improve MBD management in PD to optimize patient outcomes.

Funding

  • Commercial Support – Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details see https://www.dopps.org/AboutUs/Support.aspx.