Association of serum mineral parameters with mortality in hemodialysis patients: Data from the korean end-stage renal disease registry

Yunmi Kim, Kyung Don Yoo, Hyo Jin Kim, Junga Koh, Yeonsil Yu, Young Joo Kwon, Gheun Ho Kim, Tae Hyun Yoo, Joongyub Lee, Dong Chan Jin, Bum Soon Choi, Yeong Hoon Kim, Kook-Hwan Oh

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)266-276
Number of pages11
JournalKidney Research and Clinical Practice
Volume37
Issue number3
DOIs
StatePublished - 1 Sep 2018

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Chronic Kidney Failure
Minerals
Registries
Renal Dialysis
Mortality
Confidence Intervals
Parathyroid Hormone
Serum
Phosphorus
Calcium
Nephrology
Kidney Diseases
Guidelines

Keywords

  • Calcium
  • Hemodialysis
  • Mortality
  • Parathyroid hormone
  • Phosphorus

Cite this

Kim, Yunmi ; Yoo, Kyung Don ; Kim, Hyo Jin ; Koh, Junga ; Yu, Yeonsil ; Kwon, Young Joo ; Kim, Gheun Ho ; Yoo, Tae Hyun ; Lee, Joongyub ; Jin, Dong Chan ; Choi, Bum Soon ; Kim, Yeong Hoon ; Oh, Kook-Hwan. / Association of serum mineral parameters with mortality in hemodialysis patients : Data from the korean end-stage renal disease registry. In: Kidney Research and Clinical Practice. 2018 ; Vol. 37, No. 3. pp. 266-276.
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title = "Association of serum mineral parameters with mortality in hemodialysis patients: Data from the korean end-stage renal disease registry",
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.",
keywords = "Calcium, Hemodialysis, Mortality, Parathyroid hormone, Phosphorus",
author = "Yunmi Kim and Yoo, {Kyung Don} and Kim, {Hyo Jin} and Junga Koh and Yeonsil Yu and Kwon, {Young Joo} and Kim, {Gheun Ho} and Yoo, {Tae Hyun} and Joongyub Lee and Jin, {Dong Chan} and Choi, {Bum Soon} and Kim, {Yeong Hoon} and Kook-Hwan Oh",
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Association of serum mineral parameters with mortality in hemodialysis patients : Data from the korean end-stage renal disease registry. / Kim, Yunmi; Yoo, Kyung Don; Kim, Hyo Jin; Koh, Junga; Yu, Yeonsil; Kwon, Young Joo; Kim, Gheun Ho; Yoo, Tae Hyun; Lee, Joongyub; Jin, Dong Chan; Choi, Bum Soon; Kim, Yeong Hoon; Oh, Kook-Hwan.

In: Kidney Research and Clinical Practice, Vol. 37, No. 3, 01.09.2018, p. 266-276.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of serum mineral parameters with mortality in hemodialysis patients

T2 - Data from the korean end-stage renal disease registry

AU - Kim, Yunmi

AU - Yoo, Kyung Don

AU - Kim, Hyo Jin

AU - Koh, Junga

AU - Yu, Yeonsil

AU - Kwon, Young Joo

AU - Kim, Gheun Ho

AU - Yoo, Tae Hyun

AU - Lee, Joongyub

AU - Jin, Dong Chan

AU - Choi, Bum Soon

AU - Kim, Yeong Hoon

AU - Oh, Kook-Hwan

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

KW - Calcium

KW - Hemodialysis

KW - Mortality

KW - Parathyroid hormone

KW - Phosphorus

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U2 - 10.23876/j.krcp.2018.37.3.266

DO - 10.23876/j.krcp.2018.37.3.266

M3 - Article

AN - SCOPUS:85053527043

VL - 37

SP - 266

EP - 276

JO - Kidney Research and Clinical Practice

JF - Kidney Research and Clinical Practice

SN - 2211-9132

IS - 3

ER -