Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2011-06, Vol.26 (6), p.1938-1947
• Main Authors: NAVES-DIAZ, Manuel, PASSLICK-DEETJEN, Jutta, GUINSBURG, Adrian, MARELLI, Cristina, FERNANDEZ-MARTIN, Jose Luis, RODRIGUEZ-PUYOL, Diego, CANNATA-ANDIA, Jorge B
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Calcium - blood; Cardiovascular Diseases - mortality; Cohort Studies; Creatinine - blood; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerulonephritis; Humans; Intensive care medicine; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - mortality; Latin America; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Parathyroid Hormone - blood; Phosphorus - blood; Renal Dialysis - mortality; Retrospective Studies; Survival Rate
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq304

Mineral metabolism parameters may play a role in the survival of patients with chronic kidney disease (CKD). In the CORES Study, we analysed the association between calcium, phosphorus and PTH and mortality (all-cause and cardiovascular) in 16 173 haemodialysis (HD) patients over 18 years from six Latin American countries, who underwent haemodialysis up to 54 months. Unadjusted, case-mix-adjusted and time-dependent multivariable-adjusted hazard ratio (HR) of death were calculated for categories of serum albumin-corrected calcium (Ca(Alb)), phosphorus and PTH using as 'reference values' the range in which the lowest death rate was observed. Age, gender, vitamin D treatment, diabetes, vintage, vascular access, weight, blood pressure and laboratory variables (serum albumin, haemoglobin, creatinine, ferritin and Kt/V) were used as confounding variables. Low (10.5 mg/dL) Ca(Alb) increased the HR for all-cause mortality. Low (5.5 mg/dL) increased the HR for both all-cause and cardiovascular mortality. Low phosphorus (6.0 mg/dL increased the HR for cardiovascular hospitalizations. No effect was observed with Ca(Alb) or PTH. In summary, in 16,173 HD patients, elevated and reduced serum levels of albumin-corrected calcium, phosphorus and PTH levels were associated with increments in all-cause mortality. Similar results were obtained when only cardiovascular mortality was analysed.