Effect modifying role of serum calcium on mortality-predictability of PTH and alkaline phosphatase in hemodialysis patients: An investigation using data from the Taiwan Renal Registry Data System from 2005 to 2012

Yen Chung Lin, Yi Chun Lin, Chiao Ying Hsu, Chih Chin Kao, Fan Chi Chang, Tzen Wen Chen, Hsi Hsien Chen, Chi Cheng Hsu, Mai Szu Wu, Hung Chun Chen, Yuh Feng Lin, Han Hsiang Chen, Wu Chang Yang, Chih Wei Yang, Chih Jen Wu, Ming Ju Wu, Kwan Dun Wu, Yuan Hao Lin, Shih Hua Li, Kuan Yu HungDer Cherng Tarng, Kuo Hsiung Shu, Horng Rong Chang, Giien Shuen Chen, Jin Bor Chen, Shang Jyh Hwang, Mon Ju Yang, Chi Hung Cheng, Kuo Cheng Lu, Chiu Ching Huang, Yee Yung Ng, Chien Te Lee, Junne Ming Sung, Lian Jong-Da, Shyang Hwa Ferng, Jer Chia Tsai

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

Predicting mortality in dialysis patients based on low intact parathyroid hormone levels is difficult, because aluminum intoxication, malnutrition, older age, race, diabetes, or peritoneal dialysis may influence these levels. We investigated the clinical implications of low parathyroid hormone levels in relation to the mortality of dialysis patients using sensitive, stratified, and adjusted models and a nationwide dialysis database. We analyzed data from 2005 to 2012 that were held on the Taiwan Renal Registry Data System, and 94,983 hemodialysis patients with valid data regarding their intact parathyroid levels were included in this study. The patient cohort was subdivided based on the intact parathyroid hormone and alkaline phosphatase levels. The mean hemodialysis duration within this cohort was 3.5 years. The mean (standard deviation) age was 62 (14) years. After adjusting for age, sex, diabetes, the hemodialysis duration, serum albumin levels, hematocrit levels, calcium levels, phosphate levels, and the hemodialysis treatment adequacy score, the single-pool Kt/V, the crude and adjusted all-cause mortality rates increased when alkaline phosphatase levels were higher or intact parathyroid hormone levels were lower. In general, at any given level of serum calcium or phosphate, patients with low intact parathyroid hormone levels had higher mortality rates than those with normal or high iPTH levels. At a given alkaline phosphatase level, the hazard ratio for all-cause mortality was 1.33 (p <0.01, 95% confidence interval 1.27-1.39) in the group with intact parathyroid hormone levels <150 pg/mL and serum calcium levels > 9.5 mg/dL, but in the group with intact parathyroid hormone levels > 300 pg/mL and serum calcium levels > 9.5 mg/dL, the hazard ratio was 0.92 (95% confidence interval 0.85-1.01). Hence, maintaining albumin-corrected high serum calcium levels at > 9.5 mg/dL may correlate with poor prognoses for patients with low intact parathyroid hormone levels.

Original languageEnglish
Article numbere0129737
JournalPLoS ONE
Volume10
Issue number6
DOIs
Publication statusPublished - Jun 24 2015

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Fingerprint Dive into the research topics of 'Effect modifying role of serum calcium on mortality-predictability of PTH and alkaline phosphatase in hemodialysis patients: An investigation using data from the Taiwan Renal Registry Data System from 2005 to 2012'. Together they form a unique fingerprint.

Cite this