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 Hung & 16 others Der 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 journalArticle

14 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

Fingerprint

hemodialysis
parathyroid hormone
Parathyroid Hormone
Taiwan
Information Systems
Alkaline Phosphatase
alkaline phosphatase
Registries
Renal Dialysis
kidneys
Calcium
Dialysis
Kidney
calcium
dialysis
Mortality
Serum
Medical problems
diabetes
Hazards

ASJC Scopus subject areas

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

Cite this

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

In: PLoS One, Vol. 10, No. 6, e0129737, 24.06.2015.

Research output: Contribution to journalArticle

Lin, YC, Lin, YC, Hsu, CY, Kao, CC, Chang, FC, Chen, TW, Chen, HH, Hsu, CC, Wu, MS, Chen, HC, Lin, YF, Chen, HH, Yang, WC, Yang, CW, Wu, CJ, Wu, MJ, Wu, KD, Lin, YH, Li, SH, Hung, KY, Tarng, DC, Shu, KH, Chang, HR, Chen, GS, Chen, JB, Hwang, SJ, Yang, MJ, Cheng, CH, Lu, KC, Huang, CC, Ng, YY, Lee, CT, Sung, JM, Jong-Da, L, Ferng, SH & Tsai, JC 2015, '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', PLoS One, vol. 10, no. 6, e0129737. https://doi.org/10.1371/journal.pone.0129737
Lin, Yen Chung ; Lin, Yi Chun ; Hsu, Chiao Ying ; Kao, Chih Chin ; Chang, Fan Chi ; Chen, Tzen Wen ; Chen, Hsi Hsien ; Hsu, Chi Cheng ; Wu, Mai Szu ; Chen, Hung Chun ; Lin, Yuh Feng ; Chen, Han Hsiang ; Yang, Wu Chang ; Yang, Chih Wei ; Wu, Chih Jen ; Wu, Ming Ju ; Wu, Kwan Dun ; Lin, Yuan Hao ; Li, Shih Hua ; Hung, Kuan Yu ; Tarng, Der Cherng ; Shu, Kuo Hsiung ; Chang, Horng Rong ; Chen, Giien Shuen ; Chen, Jin Bor ; Hwang, Shang Jyh ; Yang, Mon Ju ; Cheng, Chi Hung ; Lu, Kuo Cheng ; Huang, Chiu Ching ; Ng, Yee Yung ; Lee, Chien Te ; Sung, Junne Ming ; Jong-Da, Lian ; Ferng, Shyang Hwa ; Tsai, Jer Chia. / 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. In: PLoS One. 2015 ; Vol. 10, No. 6.
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title = "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",
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.",
author = "Lin, {Yen Chung} and Lin, {Yi Chun} and Hsu, {Chiao Ying} and Kao, {Chih Chin} and Chang, {Fan Chi} and Chen, {Tzen Wen} and Chen, {Hsi Hsien} and Hsu, {Chi Cheng} and Wu, {Mai Szu} and Chen, {Hung Chun} and Lin, {Yuh Feng} and Chen, {Han Hsiang} and Yang, {Wu Chang} and Yang, {Chih Wei} and Wu, {Chih Jen} and Wu, {Ming Ju} and Wu, {Kwan Dun} and Lin, {Yuan Hao} and Li, {Shih Hua} and Hung, {Kuan Yu} and Tarng, {Der Cherng} and Shu, {Kuo Hsiung} and Chang, {Horng Rong} and Chen, {Giien Shuen} and Chen, {Jin Bor} and Hwang, {Shang Jyh} and Yang, {Mon Ju} and Cheng, {Chi Hung} and Lu, {Kuo Cheng} and Huang, {Chiu Ching} and Ng, {Yee Yung} and Lee, {Chien Te} and Sung, {Junne Ming} and Lian Jong-Da and Ferng, {Shyang Hwa} and Tsai, {Jer Chia}",
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T1 - Effect modifying role of serum calcium on mortality-predictability of PTH and alkaline phosphatase in hemodialysis patients

T2 - An investigation using data from the Taiwan Renal Registry Data System from 2005 to 2012

AU - Lin, Yen Chung

AU - Lin, Yi Chun

AU - Hsu, Chiao Ying

AU - Kao, Chih Chin

AU - Chang, Fan Chi

AU - Chen, Tzen Wen

AU - Chen, Hsi Hsien

AU - Hsu, Chi Cheng

AU - Wu, Mai Szu

AU - Chen, Hung Chun

AU - Lin, Yuh Feng

AU - Chen, Han Hsiang

AU - Yang, Wu Chang

AU - Yang, Chih Wei

AU - Wu, Chih Jen

AU - Wu, Ming Ju

AU - Wu, Kwan Dun

AU - Lin, Yuan Hao

AU - Li, Shih Hua

AU - Hung, Kuan Yu

AU - Tarng, Der Cherng

AU - Shu, Kuo Hsiung

AU - Chang, Horng Rong

AU - Chen, Giien Shuen

AU - Chen, Jin Bor

AU - Hwang, Shang Jyh

AU - Yang, Mon Ju

AU - Cheng, Chi Hung

AU - Lu, Kuo Cheng

AU - Huang, Chiu Ching

AU - Ng, Yee Yung

AU - Lee, Chien Te

AU - Sung, Junne Ming

AU - Jong-Da, Lian

AU - Ferng, Shyang Hwa

AU - Tsai, Jer Chia

PY - 2015/6/24

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N2 - 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.

AB - 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.

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