Variability in calcium, phosphorus, and parathyroid hormone in patients on hemodialysis

Levitt, Helena; Smith, Kenneth G.; Rosner, Mitchell H.

doi:10.1111/j.1542-4758.2009.00393.x

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…Furthermore, recent studies have shown that high dialysate calcium concentrations acutely raise BP and worsen arterial compliance during dialysis [28] . Prospective studies support that session-to-session variability in serum calcium and phosphate levels is a predictor of mortality in hemodialysis [29,30] . Thus, shifts in calcium phosphate product may be also implicated in elevated risk of mortality associated with the long interdialytic interval.…”

Section: Calcium and Phosphatementioning

confidence: 99%

Adverse Effects of Conventional Thrice-Weekly Hemodialysis: Is It Time to Avoid 3-Day Interdialytic Intervals?

et al. 2015

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Background: Maintenance hemodialysis is typically scheduled thrice weekly due to simple logistic reasons; thus, the vast majority of hemodialysis patients receive renal replacement therapy for two shorter 2-day intervals and a longer 3-day interval. As compared to the 2-day interval, we review the ill effects of the longer 3-day interdialytic interval in this report. Summary: Large-scale observational studies show that both cardiovascular-related hospital admissions and mortality occur more frequently on the day following the long interdialytic interval than on any other day of the week. Although the reasons for excess mortality are obscure, several pathophysiologic mechanisms may be involved, such as a greater magnitude of change during the long interdialytic interval in the following parameters: volume status, electrolyte and acid-base status, arterial wall and left ventricle mechanics. These data raise the need for re-examining the issue of timing and frequency of prescribed dialysis regimens in an attempt to improve patient outcomes. Although enhanced-frequency and/or extended-time dialysis schedules may mitigate the risks of the long interdialytic interval, the benefit of such dialytic modalities on survival is not yet proven. Key Message: This article summarizes currently available epidemiologic and pathophysiologic evidence on the adverse effects related to the long interdialytic interval of thrice-weekly hemodialysis and discusses the need to research further alternative dialysis practices that could mitigate these risks.

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Section: Calcium and Phosphatementioning

confidence: 99%

Adverse Effects of Conventional Thrice-Weekly Hemodialysis: Is It Time to Avoid 3-Day Interdialytic Intervals?

et al. 2015

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“…One such study was performed by Levitt et al who investigated 1-month session-to-session variability in 35 HD patients. They determined significant session-tosession variability in Ca, P, and iPTH (17). Sigrist et al showed that an extended interdialytic period affected Ca and P levels (18).…”

Section: Discussionmentioning

confidence: 99%

The Relation Between Variability of Intact Parathyroid Hormone, Calcium, and Cardiac Mortality in Hemodialysis Patients

Ulusoy

Özkan²,

Güvercin

et al. 2016

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Chronic kidney disease-mineral and bone disorder (CKD-BMD) is a condition known to be associated with cardiovascular disease and mortality in hemodialysis (HD) patients. The relation between calcium (Ca), phosphorus (P), and intact parathyroid hormone (iPTH) variability in HD patients and cardiac mortality is unknown. The purpose of this study was to assess the relation between variability in these parameters and cardiac mortality. Baseline demographic and biochemical parameters of 218 HD patients together with Ca values corrected with albumin and P values measured on a monthly basis and iPTH levels measured at 3-monthly intervals were recorded over 2 years. Standard deviation (SD) and smoothness index (SI) for each parameter were calculated to assess Ca, P, and iPTH variability. The relations between all parameters and cardiac mortality were then analyzed. Cardiac mortality was observed in 38 patients in the 2-year study period. Nonsurviving patients' ages, systolic and diastolic blood pressure (DBP), high sensitivity C-reactive protein (HsCRP) levels, mean iPTH, and SD iPTH were significantly higher than those of surviving patients, while albumin levels, SI iPTH and SI Ca were significantly lower. Age, low albumin, high DBP, SI iPTH, and SI Ca were identified as independent predictors of cardiac mortality at multivariate analysis. Our study shows that Ca and iPTH variability affect cardiac mortality independently of mean and baseline values. When supported by further studies, the relation between Ca and iPTH variability and cardiac mortality in HD patients can lead to a new perspective in terms of prognosis and treatment planning.

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“…This variable seemed less likely to vary widely within our population, whatever the group, as corroborated by a low SD for calcaemia in our follow-up. 16 This could be explained by the fact that calcium level is a closely regulated physiological variable. 17 Regarding baseline characteristics, differences between the 'uncontrolled SHPT' group and the other groups were observed and mainly concerned age, Charlson comorbidity index, professional status and current structure for dialysis unit.…”

Section: Discussionmentioning

confidence: 99%

Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study

et al. 2017

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ObjectivesTo define groups of patients according to the changes of biochemical parameters, that is, serum calcium, phosphate and parathyroid hormone (PTH), over a 2-year follow-up period using group-based multi-trajectory modeling (GBMM) among a cohort of dialysis patients with newly diagnosed secondary hyperparathyroidism (SHPT) (ie, PTH≥500 ng/L for the first time) and to compare their patient characteristics and treatments.DesignPharmacoepidemiological study.SettingIn the 12 dialysis units located in the French region of Lorraine.ParticipantsA total of 269 dialysis patients with newly diagnosed SHPT were prospectively included from December 2009 to May 2012 and followed-up for 2 years.ResultsWe identified four distinct trajectory groups: ‘rapid PTH drop’ experiencing a rapid and sharp decrease (over weeks) in PTH level associated with decreasing phosphate level within normal range (n=34; 12.7%), ‘gradual PTH decrease’ experiencing a gradual and continuous decrease (over months) in PTH level and maintaining phosphate at a middle level throughout the study (n=98; 36.4%), ‘slow PTH decrease with high phosphate’ experiencing a slow decrease in PTH level associated with a relatively high phosphate level (n=105; 39.0%) and ‘uncontrolled SHPT’ with high levels of PTH and phosphate throughout the study (n=32; 11.9%). Patients in the ‘uncontrolled SHPT’ group were significantly (p<0.00001) younger than patients in other groups. Kidney Disease Improving Global Outcomes (KDIGO) targets for PTH, phosphate and calcium were reached simultaneously for 14.9% of patients at baseline and 16.7% at the end of the study. Patients were given cinacalcet more frequently at months 3 and 6 in the ‘rapid PTH drop’ and at month 24 in the ‘uncontrolled SHPT’ groups.ConclusionsOver 2 years following a new SHPT diagnosis, a younger age and a higher rate of alkaline phosphatase were associated to a continuous uncontrolled SHPT. Patients with the lowest PTH at the end of the follow-up tended to receive more often cinacalcet.Trial registration numberClinicalTrials.gov number, NCT02888639, post results.

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Variability in calcium, phosphorus, and parathyroid hormone in patients on hemodialysis

Cited by 11 publications

References 15 publications

Adverse Effects of Conventional Thrice-Weekly Hemodialysis: Is It Time to Avoid 3-Day Interdialytic Intervals?

Adverse Effects of Conventional Thrice-Weekly Hemodialysis: Is It Time to Avoid 3-Day Interdialytic Intervals?

The Relation Between Variability of Intact Parathyroid Hormone, Calcium, and Cardiac Mortality in Hemodialysis Patients

Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study

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