Chronic Kidney Disease Mineral Bone Disorder and Health-Related Quality of Life Among Incident End-Stage Renal-Disease Patients

Abstract

Objective-To determine the extent to which chronic kidney disease mineral bone disorder (CKD-MBD) is associated with HRQOL among incident dialysis patients. Design-Cross-sectional analysis Setting-United States Renal Data System Dialysis Morbidity and Mortality Study (DMMS), Wave 2Patients-2590 adult participants in DMMS Wave 2 for whom quality of life and laboratory data were available Methods-We stratified patients according to their serum concentrations of phosphorus, calcium, and parathyroid hormone (PTH) and compared HRQOL as a function of these indicators in analyses adjusted for demographic, clinical, and other laboratory variables. Results-Both high and low serum phosphorus concentrations were associated with lower PCS (−1.25 to −1.48 points compared to the reference category), as was low PTH (−1.49 points). Low serum phosphorus was associated with more severe symptoms of kidney disease (−3.88 points) but there were no associations between high phosphorus or either extreme of PTH and the Symptom score. Serum calcium concentration and the calcium × phosphorus product were unassociated with PCS or Symptom scores. There were no associations among phosphorus, calcium, or PTH and MCS. Analyses simultaneously controlling for serum phosphorus, calcium, and PTH showed similar results. Main Outcome Measures-PhysicalConclusions-High and low serum phosphorus and low PTH are associated with slightly poorer self-reported physical functioning. Clinical trials will be necessary to determine whether and to what extent improvement in health status may occur with correction of selected disorders of mineral metabolism.

Bone Mineral Metabolism and Subsequent Hospitalization With Poor Quality of Life in Dialysis Patients

“…However, similar to our study, serum phosphorus level did not have any effect on MCS scores (13), and kidney disease symptoms. Nevertheless, another prior study demonstrated that high serum phosphorus levels management was associated with a considerable pill burden that was accompanying with lower quality of life in individuals with CKD (16).…”

“…Likewise, admission in hospital would have been increased in association with hyperphosphatemia, high serum calcium level, and markedly increased serum PTH levels (13, 14, 25, 26) even in community-based sample of individuals without baseline CKD (26). On the other hand, another study found that the high mortality risk might be observed in low serum PTH levels (26).…”

“…Therefore, achievement to a sustain level of serum calcium, phosphate, calcium-phosphate product, and parathyroid hormone (PTH) with current therapeutic strategies would be challenging (12). Thus, it is probable that disordered mineral metabolism could be associated with impaired HRQOL and must be modified (13) with new evidences.…”

Paratireoidectomia na doença renal crônica: efeitos no ganho de peso e na melhora da qualidade de vida

“…The poor quality of life was evident before surgery, not directly related to the duration of the disease, as demonstrated 26,27 . However, the procedure had an important beneficial effect, which can be explained by the reduction of the toxic effects of PTH, causing multiple organ damage and exuberant symptomatology 28 .…”

Bone mineral density and parathyroid function in patients on maintenance hemodialysis

“…They are responsible for disabling symptoms and consequences [1,2], impaired quality of life [3] and even increased mortality [4]. CKD-associated mineral and bone disorder has been identified as a potential risk factor for cardiovascular morbidity and mortality in this patient population [1,5]; hence, the term CKDmineral and bone disorder (CKD-MBD) has been suggested to describe the complexity of the syndrome [2].…”