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Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population

Open access
Floege, J., Kim, J., Ireland, E., Chazot, C., Drueke, T., de Francisco, A., Kronenberg, F., Marcelli, D., Passlick-Deetjen, J., Schernthaner, G., Fouqueray, B., Wheeler, D. C., on behalf of the ARO Investigators·2011·Nephrology Dialysis Transplantation

Abstract

BACKGROUND: A number of US observational studies reported an increased mortality risk with higher intact parathyroid hormone (iPTH), calcium and/or phosphate. The existence of such a link in a European haemodialysis population was explored as part of the Analysing Data, Recognising Excellence and Optimising Outcomes (ARO) Chronic Kidney Disease (CKD) Research Initiative. METHODS: The association between the markers of mineral and bone disease and clinical outcomes was examined in 7970 patients treated in European Fresenius Medical Care facilities over a median of 21 months. Baseline and time-dependent (TD) Cox regression were performed using Kidney Disease Outcomes Quality Initiative (KDOQI) target ranges as reference categories, adjusting for demographics, medical history, dialysis parameters, inflammation, medications and laboratory parameters. Fractional polynomial (FP) models were also used. RESULTS: Hazard ratio (HR) estimates from baseline analysis for iPTH were U-shaped [>600 pg/mL, HR = 2.10, 95% confidence interval (CI) 1.62-2.73; <75 pg/mL, HR = 1.46, 95% CI 1.17-1.83]. TD analysis confirmed the results for iPTH. Baseline analysis showed that calcium >2.75 mmol/L increased risk of death (HR = 1.70, 95% CI 1.19-2.42). TD analysis showed that both low (HR = 1.19, 95% CI 1.04-1.37) and high calcium (HR = 1.74, 95% CI 1.30-2.34) increased risk of death. Baseline analysis for phosphate showed a U-shaped pattern (<1.13 mmol/L, HR = 1.18, 95% CI 1.01-1.37; >1.78 mmol/L, HR = 1.32, 95% CI 1.13-1.55). TD analysis confirmed the results for phosphate <1.13 mmol/L. HR estimates were higher in patients with diabetes versus those without diabetes for baseline analysis only (P-value = 0.014). FP analysis confirmed the results of baseline and TD analyses. CONCLUSION: Patients with iPTH, calcium and phosphate levels within the KDOQI target ranges have the lowest risk of mortality compared with those outside the target ranges.

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Metadata

Authors
Floege, J., Kim, J., Ireland, E., Chazot, C., Drueke, T., de Francisco, A., Kronenberg, F., Marcelli, D., Passlick-Deetjen, J., Schernthaner, G., Fouqueray, B., Wheeler, D. C., & on behalf of the ARO Investigators
Venue
Nephrology Dialysis Transplantation
Published
2010-04-25
Volume
26
Issue
6
Pages
1948-1955
ISSN
  • 0931-0509 (ISSN-L)
  • 1460-2385
OpenAlex
W2138829372
Cited by
477
References
25
FWCI
18.98
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. https://app.cochat.ai/papers/10.1093/ndt/gfq219
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Floege, J., Kim, J., Ireland, E., Chazot, C., Drueke, T., de Francisco, A., Kronenberg, F., Marcelli, D., Passlick-Deetjen, J., Schernthaner, G., Fouqueray, B., Wheeler, D. C., & on behalf of the ARO Investigators. (2011). Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfq219

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