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 language | English |
|---|---|
| Pages (from-to) | 1542-1551 |
| Number of pages | 10 |
| Journal | Nephrology Dialysis Transplantation |
| Volume | 30 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 Sep 2015 |
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Keywords
- Calcium
- chronic kidney disease
- CKD-MBD
- cosmos
- hemodialysis
- phosphorous
- PTH
- survival
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Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients : The COSMOS study. / Fernandez-Martin, Jose Luis; Martinez-Camblor, Pablo; Dionisi, Maria Paula; Floege, Jürgen; Ketteler, Markus; London, Gerard; Locatelli, Francesco; Gorriz, Jose Luis; Rutkowski, Boleslaw; Ferreira, Anibal; Bos, Willem Jan; Covic, Adrian; Rodriguez-Garcia, Minerva; Sanchez, Jose Emilio; Rodriguez-Puyol, Diego; Cannata-Andia, Jorge B.
In: Nephrology Dialysis Transplantation, Vol. 30, No. 9, 01.09.2015, p. 1542-1551.Research output: Contribution to journal › Article
TY - JOUR
T1 - Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients
T2 - The COSMOS study
AU - Fernandez-Martin, Jose Luis
AU - Martinez-Camblor, Pablo
AU - Dionisi, Maria Paula
AU - Floege, Jürgen
AU - Ketteler, Markus
AU - London, Gerard
AU - Locatelli, Francesco
AU - Gorriz, Jose Luis
AU - Rutkowski, Boleslaw
AU - Ferreira, Anibal
AU - Bos, Willem Jan
AU - Covic, Adrian
AU - Rodriguez-Garcia, Minerva
AU - Sanchez, Jose Emilio
AU - Rodriguez-Puyol, Diego
AU - Cannata-Andia, Jorge B.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - 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.
AB - 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.
KW - Calcium
KW - chronic kidney disease
KW - CKD-MBD
KW - cosmos
KW - hemodialysis
KW - phosphorous
KW - PTH
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=84940704357&partnerID=8YFLogxK
U2 - 10.1093/ndt/gfv099
DO - 10.1093/ndt/gfv099
M3 - Article
VL - 30
SP - 1542
EP - 1551
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
SN - 0931-0509
IS - 9
ER -