Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study

Abstract

In summary, in 16,173 HD patients, elevated and reduced serum levels of albumin-corrected calcium, phosphorus and PTH levels were associated with increments in all-cause mortality. Similar results were obtained when only cardiovascular mortality was analysed.

Hyperphosphatemia in Chronic Kidney Disease: Patient Characteristics and Dialysis Mortality during the First Year of Dialysis

“…All of these factors contribute to regulating the renal tubular phosphate reabsorption capacity and might explain the lower phosphate excretion and then the higher serum phosphate level observed in women than in men [30]. The literature about the association we found between hyperphosphatemia and diabetic nephropathy is largely conflicting: some investigators report similar result to ours [21,23,31] but others describe the opposite, with less hyperphosphatemia in diabetic CKD patients [9,10,19]. Additional studies are warranted to evaluate the precise link between diabetes and phosphatemia and its mechanism.…”

“…The association between hyperphosphatemia and lower age is now well recognized, as it has been shown in several previous studies in different settings: in the community setting, this association was found in a general population [19], a diabetic population [20], and a CKD population [21]; in the hospital setting, the association was shown in vascular patients scheduled for major surgery [22] and also in a dialysis population [9,10]. Various mechanisms may explain this association, including increased undernutrition with age, decreased renal phosphate reabsorption, and hormonal factors.…”

“…Others provided evidence that calcium-phosphate metabolism disorders, and particularly excess serum phosphate, are implicated in cardiovascular morbidity and mortality through the formation of vascular calcifications [4][5][6][7]. To date, the relationship between high serum phosphate levels and allcause or cardiovascular mortality has been explored among patients receiving dialysis treatment [8][9][10][11][12], pre-dialysis CKD patients [13,14], and even the general population [15]. However, to our knowledge, no study has yet evaluated the impact of high serum phosphate levels in CKD patients before the initiation of dialysis on their morbidity and mortality after starting dialysis.…”

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

“…It is also important to emphasize that classic US KDOQI limits between 150 and 300 pg/ml have been associated (88,89). Therefore, some authors and guidelines continue to recommend these "old" targets, or even lower ones (90), although a correction of PTH values for the kit utilized is currently advised in order to take into account the great variability in PTH assays (i.e., approximately 2-5 times the upper limit of normality for a particular PTH assay) (6,7,(91)(92)(93).…”

Health technology assessment of hyperphosphatemia management among hemodialysis patients in Lebanon

“…Given the striking baseline differences in key parameters, it was impossible to draw a firm conclusion about the costeffectiveness of the DD protocol. At baseline, the DD group had the highest MIS and serum phosphorus, which reportedly predict increased mortality, days and frequency of hospitalization, as well as lower QOL [5,[64][65][66][72][73][74][75]. These factors made it practically impossible for intensive nutrition education to be cost-effective.…”