Relationship between serum calcium or phosphate levels and mortality stratified by parathyroid hormone level: an analysis from the MBD-5D study

Slow-Reflow and Prognosis in Patients with High Parathyroid Hormone Levels Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction

We aimed to evaluate the correlation among serum parathyroid hormone (PTH) and slow-reflow during primary percutaneous coronary intervention (PCI) and prognosis in patients with ST-segment elevation myocardial infarction (STEMI). A total of 262 patients were enrolled and divided into a slow-reflow group (n = 61) and a control group (n = 201). PTH was an independent risk factor for slow-reflow (P < 0.05), and the regression model had good discrimination and calibration. ROC curve analysis showed that PTH (≥ 63.65 pg/ml) had a predictive value for slow-reflow (P < 0.001). During the 1-year follow-up, the patients were divided into a PTH-h group (≥ 63.65 pg/ml, n = 100) and a PTH-l group (< 63.65 pg/ml, n = 162). Readmission for HF was independently associated with PTH levels (P < 0.05). KM survival analysis suggested that PTH-h had a predictive value for MACEs, especially for readmission for HF (P < 0.05). PTH levels were associated with slow-reflow during PCI and MACEs during follow-up in patients with STEMI.

The effect of a training program on the self-care efficacy of hemodialysis patients with mineral and bone disorders: A quasi-experimental study

Background and Aims

Patients who have chronic kidney disease (CKD) and mineral and bone disorders (MBD) often do not know much about their diseases. A training program can help them improve their quality of life. This study aimed to assess the effect of a training program on the self-care efficacy of the hemodialysis patients with MBDs in southeastern Iran.

Method

We conducted a quasi-experimental study involving 49 patients with CKD-MBD in southeastern Iran in 2021. The patients were randomly assigned to either the control or intervention group. The intervention group received 12 self-care training sessions delivered through WhatsApp, whereas the control group received routine information. We administered CKD-MBD knowledge and behavior questionnaires of the intervention, and measured laboratory parameters before and 1 month after the intervention. The data were analyzed by SPSS15 with descriptive and analytical statistics. Paired t test, independent t, analysis of covariance, and Mann-Whitney U tests were using for data analysis.

Results

The mean knowledge scores of the control group were 4.78 ± 1.78 and 6.22 ± 2.11 before and after the intervention, respectively (p = 0.200), whereas the mean knowledge scores of the intervention group were 6.08 ± 2.24 and 22.23 ± 4.55 before and after the intervention, respectively (p = 0.001). The mean behavior scores of the control and intervention groups were 75.61 ± 7.13 and 73.85 ± 7.49 before the intervention, respectively (p = 0.070), but they received the mean scores of 78.87 ± 5.58 and 82.50 ± 5.35 after the intervention, respectively (p = 0.001). The result showed a significant increase in the mean knowledge and behavior scores after the intervention. The researchers found no significant difference in the mean scores of the laboratory parameters between them before and after the intervention (p = 0.090); therefore, the intervention could not affect the laboratory parameters.

Conclusion

To sum up, the study found that the training program improved the knowledge and behavior of hemodialysis patients with MBD. WhatsApp was a good and cheap way to teach them self-care, and it helped them do it better. These results implied that this training program could help the patients have a better quality of life.

Calcimimetic use in US hemodialysis facilities in first 2 years after the launch of etelcalcetide: A descriptive analysis of real-world clinical practice and outcomes

INTRODUCTION

This study described control of parathyroid hormone (PTH), phosphorus, and corrected calcium in adults initiating calcimimetics in small dialysis organizations after the introduction of etelcalcetide.

METHODS

This retrospective study using Visonex Clarity electronic health records between October 1, 2017, and December 31, 2019, identified adults ≥ 18 years of age receiving in-center hemodialysis as either a cinacalcet or etelcalcetide initiator based on their first calcimimetic use in 2018 (index date) with no prior calcimimetic use in the 3 months preindex date. Patients were stratified by PTH at index date and were followed for 15 months. Subcohorts of patients who were persistent on a single calcimimetic for 15 months and of patients who had their calcimimetic changed from cinacalcet to etelcalcetide were also analyzed.

FINDINGS

A total of 677 patients initiated cinacalcet and 711 initiated etelcalcetide. Mean PTH (pg/ml), phosphorus, and corrected calcium (mg/dl) at baseline were 864, 5.9, and 9.3 for cinacalcet and 804, 5.9, and 9.4 for etelcalcetide, respectively. During follow-up, the proportion of initiators considered in-target (monthly average PTH < 600) increased from 48% to 62% with cinacalcet and from 56% to 86% with etelcalcetide in the baseline PTH 600 to < 800 subgroup; increased from 30% to 64% with cinacalcet and 31% to 59% with etelcalcetide among those with baseline PTH 800 to < 1000; and increased from 14% to 41% with cinacalcet and 12% to 58% with etelcalcetide among those with baseline PTH ≥1000. A similar pattern was observed for persistent users (n = 646). For patients changed from cinacalcet to etelcalcetide (n = 183), the proportion of patients considered in-target increased from 22% in the month prior to the treatment change to 51% in Month 6 postchange.

DISCUSSION

Patients initiating calcimimetics at lower baseline PTH had better biochemical control than patients starting at higher PTH. Patients changed from cinacalcet to etelcalcetide had improvements in PTH control postchange.

Association of Serum Parathyroid Hormone Levels With All-Cause and Cause-Specific Mortality Among U.S. Adults

OBJECTIVE

To examine whether parathyroid hormone (PTH) is associated with mortality among U.S. adults.

METHODS

This study included 8286 U.S. adults aged ≥20 years with a measurement of serum intact PTH from the National Health and Nutrition Examination Survey 2003-2006 linked to national mortality data through 2015. Multivariable Cox proportional hazard regression models were employed to estimate the adjusted hazard ratio (aHR) of all-cause and cause-specific (cardiovascular and cancer) mortality according to intact PTH levels (low or low-normal, <38; middle-normal, 38-56; high-normal, 57-74; high, >74 pg/mL). We also stratified the analyses by serum albumin-adjusted calcium and 25-hydroxy vitamin D (25OHD) levels.

RESULTS

During a median follow-up of 10.1 years, the mean age was 49 years, and 48% were men. After adjusting for potential confounders, both the high-normal and high PTH groups showed higher risks of all-cause mortality than the low or low-normal PTH group (high-normal PTH, aHR, 1.28; 95% confidence interval [CI], 1.10-1.48; high PTH, aHR, 1.42; 95% CI, 1.19-1.69]. When stratified by calcium and 25OHD levels, the association between high PTH and mortality was also found among participants with albumin-adjusted calcium levels of ≥9.6 mg/dL (aHR, 1.53; 95% CI, 1.17-2.01) and those with 25OHD levels of ≥20 ng/mL (aHR, 1.46, 95% CI, 1.17-1.82). We found no evidence of the increased cause-specific mortality risks in the high PTH group.

CONCLUSION

Higher PTH levels were associated with an increased risk of all-cause mortality, particularly among participants with albumin-adjusted calcium levels of ≥9.6 mg/dL or 25OHD levels of ≥20 ng/mL.

Effect of Magnesium Supplementation on Chronic Kidney Disease-Mineral and Bone Disorder in Hemodialysis Patients: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

Research about the effects of magnesium (Mg) supplementation on chronic kidney disease-mineral bone disorder (CKD-MBD) among hemodialysis (HD) patients is controversial. Thus, we conducted a meta-analysis to examine Mg supplementation's effects on CKD-MBD in patients requiring dialysis.

METHODS

The PubMed and EMBASE databases were searched for English language studies up to September 2020. The main indicators of our study were changes in serum Mg, calcium (Ca), phosphate, parathyroid hormone (PTH), and C-reactive protein levels, and carotid intima-media thickness (CIMT) after Mg supplementation. Mg efficacy was evaluated by weighted mean difference (WMD) and confidence intervals (CIs), and subgroup analyses of intervention type and intervention duration were also performed.

RESULTS

Eight eligible studies comprising 309 HD patients were included in our meta-analysis. Mg supplementation alone produced a negative effect on serum PTH levels (WMD = -236.56; 95% CI -349.71 to -123.41) and CIMT (WMD = -0.18; 95% CI -0.34 to -0.01). A subgroup analysis based on intervention type showed a significant improvement in serum Mg (WMD = 1.08; 95% CI 0.51-1.64) and Ca (WMD = -0.50; 95% CI -0.77 to -0.23) levels when Mg was administered via dialysate and oral medication, respectively. Different intervention durations had no effect on serum Mg levels. Mg supplementation had no significant effect on serum phosphate (WMD = -0.25; 95% CI -0.64 to 0.14) and C-reactive protein levels (WMD = -0.02; 95% CI -2.80 to 2,76).

CONCLUSIONS

Our results showed that Mg supplementation alone could improve CKD-MBD by regulating serum Ca and PTH metabolism and decreasing CIMT among HD patients.

The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients

The serum intact parathyroid hormone (iPTH) is associated with the prognosis of hemodialysis (HD) patients, however, its optimal range for reducing mortality remains inconsistent. We designed a prospective cohort study of 346 incident HD patients to assess the association between different serum iPTH level and mortality. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) international guidelines (2003), we divided patients into three groups (iPTH < 150 pg/mL, 150–300 pg/mL and >300 pg/mL). During the median follow-up of 58 months, 157 patients (45.38%) died. Multivariate Cox regression analysis showed that iPTH < 150 pg/mL and >300 pg/mL were associated with all-cause and cardiovascular mortality. Then, we performed a sensitivity analysis of patients divided into 6 serum PTH levels groups according to the folds of the K/DOQI target range. Multivariate Cox regression analysis showed that patients with serum iPTH ≥750 pg/mL, 600–749 pg/mL, 450–599 pg/mL had significantly higher risk of all-cause and cardiovascular mortality compared with those with serum iPTH in the range of 150–299 pg/mL. The association between serum iPTH and mortality shows a U-shaped curve. The optimal serum iPTH level which confers the lowest risk of all-cause and cardiovascular mortality could range from 150 pg/mL to 450 pg/mL in this group of incident HD patients.