Calcium, Phosphorus, Cardiovascular Events and All-cause Mortality in Hemodialysis Patients: A Single-center Retrospective Cohort Study to Reassess the Validity of the Japanese Society for Dialysis Therapy Guidelines

:  Mineral and bone disorders frequently cause cardiovascular complications and mortality in hemodialysis patients, but few observational studies of Japanese patients have investigated this matter. A retrospective cohort study of 99 patients (53 males, 46 females; mean age: 65 ± 12 year; 38% with di...

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Published in:Therapeutic apheresis and dialysis 2008-02, Vol.12 (1), p.42-48
Main Authors: Komaba, Hirotaka, Igaki, Naoya, Takashima, Mototsugu, Goto, Shunsuke, Yokota, Kazuki, Komada, Hisako, Takemoto, Toshiyuki, Kohno, Maki, Kadoguchi, Hiraku, Hirosue, Yoshiaki, Goto, Takeo
Format: Article
Language:English
Subjects:
Aged
Asian Continental Ancestry Group
Calcium
Calcium - blood
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - etiology
Cardiovascular Diseases - prevention & control
Cardiovascular event
Cohort Studies
Female
Follow-Up Studies
Hemodialysis patient
Humans
Incidence
Japan
JSDT guidelines
Male
Middle Aged
Parathyroid Hormone - blood
Phosphorus
Phosphorus - blood
Practice Guidelines as Topic
Proportional Hazards Models
Renal Dialysis - mortality
Retrospective Studies
Secondary hyperparathyroidism
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Summary::  Mineral and bone disorders frequently cause cardiovascular complications and mortality in hemodialysis patients, but few observational studies of Japanese patients have investigated this matter. A retrospective cohort study of 99 patients (53 males, 46 females; mean age: 65 ± 12 year; 38% with diabetes mellitus) on maintenance hemodialysis in our dialysis center was conducted. Mean serum Ca, P and intact parathyroid hormone (iPTH) levels were 9.2 ± 0.9 mg/dL, 6.1 ± 1.7 mg/dL, and 233 ± 333 pg/mL, respectively. The cutoff values for each of these three parameter were defined according to the target ranges recommended by the Japanese Society for Dialysis Therapy (JSDT) guidelines (Ca: 8.4–10.0 mg/dL; P: 3.5–6.0 mg/dL; iPTH: 60–180 pg/mL). During a 45‐month follow up, patients with all parameters outside the target ranges showed the highest incidence of cardiovascular events and all‐cause deaths (16.6 and 29.2 per 1000 person‐years, respectively). The relative risks of cardiovascular events and all‐cause deaths were analyzed by multivariate Cox regression models. The hazard ratio (HR) for cardiovascular events was significantly lower for patients who achieved serum Ca and P objectives compared with others (HR: 2.12; 95% CI: 1.04–4.34; P 
ISSN:1744-9979
1744-9987
DOI:10.1111/j.1744-9987.2007.00539.x