Comparative Mortality–Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

Rhee, Connie M.; Molnar, Miklos Z.; Lau, Wei Ling; Ravel, Vanessa; Kövesdy, Csaba P.; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

doi:10.3747/pdi.2013.00110

Cited by 51 publications

(73 citation statements)

References 54 publications

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“…26,27 In addition, serum albumin levels were found to be an independent predictor of mortality in recent studies in this population. 28,29 The main reason for hypoalbuminemia commonly seen in PD patients is the loss of serum albumin approximately 4 g/day through peritoneal effluent.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Türkmen¹,

Güney²,

Yazıcı³

et al. 2014

Renal Failure

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Introduction: Impairment of health-related quality of life (HRQoL) and being in a depressive mood were found to be associated with increased mortality in peritoneal dialysis (PD) patients. We aimed to investigate the association between HRQoL, depression, other factors and mortality in PD patients. Materials and methods: Totally 171 PD patients were included and followed for 7 years in this prospective study. Results: Of 171 PD patients, 45 (26.3%) deceased, 18 (10.5%) maintained on PD, 87 (50.9%) shifted to hemodialysis (HD) and 21 (12.3%) underwent transplantation. The most common cause of death was cardiovascular disease (32, 71.1%) followed by infection (6, 13.3%), cerebrovascular accident (5, 11.2%). The etiology of patients who shifted to HD was PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), catheter dysfunction (3, 3.4%), self willingness (4, 4.6%). Non-survivors were older than survivors (56.6 ± 15.0 vs. 43.6 ± 14.6, p ¼ 0.003). There were also statistically significant difference in terms of albumin, residual urine, presence of diabetes and co-morbidity. When the groups were compared regarding HRQoL scores, non-survivors had lower physical functioning (p50.001), role-physical (p ¼ 0.0045), general health (p ¼ 0.004), role-emotional (p ¼ 0.011), physical component scale (PCS) (p ¼ 0.004), mental component scale (MCS) (p ¼ 0.029). Age, presence of residual urine, diabetes, albumin, PCS and MCS were entered in regression analysis. Decrease of 1 g/dL of albumin and being diabetic were found to be the independent predictors of mortality. Conclusions: Diabetes and hypoalbuminemia but not HRQOL scores were associated with higher mortality in PD patients after 7 years of following period.

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Section: Discussionmentioning

confidence: 99%

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Türkmen¹,

Güney²,

Yazıcı³

et al. 2014

Renal Failure

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“…However, patients on peritoneal dialysis have higher levels of serum PTH than those on hemodialysis [29,30] , but do not have reduced survival compared to hemodialysis patients [18] . Although earlier studies showed that peritoneal dialysis was associated with adynamic bone disease and low serum PTH [31] , the subsequent use of low-calcium peritoneal dialysate was associated with a rise in the serum PTH [32] .…”

Section: Discussionmentioning

confidence: 99%

Femoral Neck X-Ray Absorptiometry Parameters and Peripheral Quantitative Computer Tomography Tibial Cortical Density Predict Survival in Dialysis Patients

Yap¹,

Wong²,

McGinn

et al. 2017

Nephron

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Background: Low bone mineral density (BMD) is a known independent predictor of mortality in the general elderly population. However, studies in patients with end-stage renal disease (ESRD) are limited. The present study evaluated mortality during long-term follow-up in a population of patients having dialysis for ESRD, in whom BMD was also measured. Methods: Fifty-eight patients with ESRD were recruited consecutively from a dialysis clinic and followed prospectively for 6 years. Baseline BMD of the lumbar spine and femoral neck (FN) were measured by X-ray absorptiometry and by peripheral quantitative CT at the radius and tibia. Serum calcium, phosphate, parathyroid hormone (PTH), and albumin were measured at baseline. Results: During follow-up, 25 patients died. Univariate analysis showed that mortality was significantly associated with FN-BMD: hazards ratio (HR) per 0.1 g/cm² decrease 1.50 (95% CI 1.07-2.10), p = 0.019; FN-T score: HR per 1-SD decrease 1.84 (95% CI 1.16-2.92), p = 0.009; and tibial cortical density: HR per 10 mg/cm³ decrease 1.08 (95% CI 1.02-1.14), p = 0.010. In multivariate analysis with stepwise adjustment for age, sex, transplant status, albumin, PTH, phosphate, dialysis duration, diabetes, and smoking, FN-T score remained significantly associated with mortality: HR per 1-SD decrease 1.82 (95% CI 1.02-3.24), p = 0.044, whereas the HR for FN-BMD and tibial cortical density were no longer significant. When 4 patients who had peritoneal dialysis were excluded, the HR relating FN-BMD, FN-T score, and tibial cortical density to mortality remained significant but became insignificant when albumin was included in the multivariate analysis. Conclusion: Reduced FN-BMD, FN-T score, and tibial cortical density were significantly associated with an increased risk of death in patients with ESRD.

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“…It was likewise advised that ALP levels were more consistent with mortality than PTH, Ca and P concentrations [43,44]. Moreover, bone-specific alkaline phosphatase (bALP) is still considered valuable as a marker of bone turnover [18] because bALP contributes to the diagnosis, fracture risk prediction and fracture prognosis of CKD-MBD patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ascorbic Acid on Mineral and Bone Disorders in Hemodialysis Patients: a Systematic Review and Meta-Analysis

Huang

Zhu

et al. 2018

Kidney Blood Press Res

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Background/Aims: Hemodialysis (HD) patients often have inadequate nutrition, especially with respect to ascorbic acid (AA). It is reported that every HD session may cause a 50%– 75% decrease in plasma AA levels. Some studies have shown that supplementation of AA can change the outcome of chronic kidney disease-mineral bone disorders (CKD-MBD), but the effect of AA on HD patients with CKD-MBD remains controversial. Consequently, we decided to perform a meta-analysis to evaluate the efficacy of AA supplementation in CKD-MBD patients requiring dialysis. Methods: A search was conducted using Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure (CNKI), Wanfang database and VIP information database up to April 2018 for all English and Chinese language publications. The main indicators of our study were changes in serum phosphate (P), calcium (Ca) and parathyroid hormone (PTH) levels after AA treatment. The efficacy of AA was evaluated by weighted mean difference (WMD) and confidence intervals (CI). Cardiovascular events, mortality and adverse events reported during the experiment were also noted. Results: In total, 371 patients in six studies were involved in this meta-analysis. Compared to placebo, AA treatment had no positive effect on serum P (353 patients; WMD = -0.05; 95% CI, -0.3 to 0.2; I² = 28%) or PTH levels (275 patients; WMD = -17.04; 95%CI, -63.79 to 29.72; I² = 75%). The pooled mean difference of the change of Ca levels from baseline was higher in the AA therapy group versus placebo (353 patients; WMD = 0.15; 95% CI, 0.01 to 0.3; I² = 0%). No side effects were observed. Conclusion: Our systematic review and meta-analysis does not support prescription of AA to HD patients with CKD-MBD. AA had no positive effect on CKD-MBD patients as it couldn’t influence the serum P or PTH levels but did raise serum Ca levels in the short-term.

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Comparative Mortality–Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

Cited by 51 publications

References 54 publications

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center

Femoral Neck X-Ray Absorptiometry Parameters and Peripheral Quantitative Computer Tomography Tibial Cortical Density Predict Survival in Dialysis Patients

Effect of Ascorbic Acid on Mineral and Bone Disorders in Hemodialysis Patients: a Systematic Review and Meta-Analysis

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