Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: The COSMOS study

Jose Luis Fernandez-Martin, Pablo Martinez-Camblor, Maria Paula Dionisi, Jürgen Floege, Markus Ketteler, Gerard London, Francesco Locatelli, Jose Luis Gorriz, Boleslaw Rutkowski, Anibal Ferreira, Willem Jan Bos, Adrian Covic, Minerva Rodriguez-Garcia, Jose Emilio Sanchez, Diego Rodriguez-Puyol, Jorge B. Cannata-Andia

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Abstract

Background Abnormalities in serum phosphorus, calcium and parathyroid hormone (PTH) have been associated with poor survival in haemodialysis patients. This COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis assesses the association of high and low serum phosphorus, calcium and PTH with a relative risk of mortality. Furthermore, the impact of changes in these parameters on the relative risk of mortality throughout the 3-year follow-up has been investigated. Methods COSMOS is a 3-year, multicentre, open-cohort, prospective study carried out in 6797 adult chronic haemodialysis patients randomly selected from 20 European countries. Results Using Cox proportional hazard regression models and penalized splines analysis, it was found that both high and low serum phosphorus, calcium and PTH were associated with a higher risk of mortality. The serum values associated with the minimum relative risk of mortality were 4.4 mg/dL for serum phosphorus, 8.8 mg/dL for serum calcium and 398 pg/mL for serum PTH. The lowest mortality risk ranges obtained using as base the previous values were 3.6-5.2 mg/dL for serum phosphorus, 7.9-9.5 mg/dL for serum calcium and 168-674 pg/mL for serum PTH. Decreases in serum phosphorus and calcium and increases in serum PTH in patients with baseline values of >5.2 mg/dL (phosphorus), >9.5 mg/dL (calcium) and <168 pg/mL (PTH), respectively, were associated with improved survival. Conclusions COSMOS provides evidence of the association of serum phosphorus, calcium and PTH and mortality, and suggests survival benefits of controlling chronic kidney disease-mineral and bone disorder biochemical parameters in CKD5D patients.

Original languageEnglish
Pages (from-to)1542-1551
Number of pages10
JournalNephrology Dialysis Transplantation
Volume30
Issue number9
DOIs
Publication statusPublished - 1 Sep 2015

Keywords

  • Calcium
  • chronic kidney disease
  • CKD-MBD
  • cosmos
  • hemodialysis
  • phosphorous
  • PTH
  • survival

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    Fernandez-Martin, J. L., Martinez-Camblor, P., Dionisi, M. P., Floege, J., Ketteler, M., London, G., ... Cannata-Andia, J. B. (2015). Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: The COSMOS study. Nephrology Dialysis Transplantation, 30(9), 1542-1551. https://doi.org/10.1093/ndt/gfv099