Kidney Res Clin Pract.
2018 Sep;37(3):266-276. 10.23876/j.krcp.2018.37.3.266.
Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry
- Affiliations
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- 1Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
- 2Department of Internal Medicine, Gangneung Dongin Hospital, Gangneung, Korea.
- 3Department of Internal Medicine, J Hospital, Seongnam, Korea.
- 4Division of Nephrology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
- 5Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
- 6Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 7School of Medicine, Inha University, Incheon, Korea.
- 8Department of Prevention and Management, Inha University Hospital, Incheon, Korea.
- 9Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- 10Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
- 11Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. khoh@snu.ac.kr
- KMID: 2447166
- DOI: http://doi.org/10.23876/j.krcp.2018.37.3.266
Abstract
- BACKGROUND
We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients.
METHODS
Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed.
RESULTS
Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; P = 0.003).
CONCLUSION
In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.
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