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Huo Z, Liu D, Ye P, Zhang Y, Cao L, Gong N, Dou X, Ren C, Zhu Q, Li D, Zhang W, Kong Y, Wang G, Ai J. Longer serum phosphorus time in range associated with lower mortality risk among peritoneal dialysis patients: a multicenter retrospective cohort study. BMC Nephrol 2024; 25:117. [PMID: 38553732 PMCID: PMC10981292 DOI: 10.1186/s12882-023-03395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/09/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Relationship between serum phosphorus time in range and mortality risk in peritoneal dialysis (PD) patients remains uncertain. We aimed to evaluate the association between serum phosphorus time in range and all-cause mortality in Chinese PD population. METHODS This was a multicenter, retrospective, cohort study of 1,915 patients collected from January 2008 to October 2020 in 4 Chinese centers. Serum phosphorus time in range was estimated as the months during the first year that a patient's serum phosphorus level was within the target range (defined as 1.13-1.78 mmol/L). The primary outcome was all-cause mortality. The secondary outcomes were cardiovascular (CV) mortality and PD withdrawal. Cox proportional hazards regression model with comprehensive adjustments was used to assess the association. RESULTS The primary outcome occurred in 249 (13.0%) PD patients over a median follow-up of 28 months. Overall, the serum phosphorus time in range was negatively associated with all-cause mortality (per 3-month increments, adjusted HR [aHR], 0.83; 95%CI: 0.75-0.92), CV mortality (per 3-month increments, aHR, 0.87; 95%CI: 0.77-0.99), and PD withdrawal (per 3-month increments, aHR, 0.89; 95%CI: 0.83-0.95). Competing-risk model showed that the relationship of serum phosphorus time in range with all-cause mortality remained stable. None of the variables including demographics, history of diabetes and CV disease, as well as several PD-related and clinical indicators modified this association. CONCLUSIONS PD patients with longer serum phosphorus time in range in the first year was negatively associated with all-cause mortality and CV mortality. Our findings highlight the importance of maintaining serum phosphorus levels within 1.13-1.78 mmol/L for PD patients.
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Affiliation(s)
- Zhihao Huo
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- Department of Nephrology, Guangdong Clinical Research Academy of Chinese Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dehui Liu
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People's Hospital), Ganzhou, China
| | - Peiyi Ye
- Nephrology Department, The First People's Hospital of Foshan, Foshan, China
| | - Yuehang Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Lisha Cao
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Nirong Gong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Chengfa Ren
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People's Hospital), Ganzhou, China
| | - Qingyao Zhu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Dan Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Wei Zhang
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yaozhong Kong
- Nephrology Department, The First People's Hospital of Foshan, Foshan, China
| | - Guobao Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
| | - Jun Ai
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
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He C, Zhang Y, Li L, Cheng G, Zhang W, Tang Y, Wang C. Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism. Int J Endocrinol 2023; 2023:1901697. [PMID: 36700169 PMCID: PMC9870689 DOI: 10.1155/2023/1901697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. METHODS A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. RESULTS The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816-0.916) and 0.867 (95% CI, 0.793-0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%-78.4%) and 75.0% (58.6%-88.5%), and negative predictive values of the nomogram were 90.0% (82.9%-93.6%) and 86.4% (73.5%-94.0%) for the training and validation cohorts, respectively. CONCLUSIONS We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making.
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Affiliation(s)
- Chenchen He
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
- China Medical University, Shenyang, China
| | - Yibing Zhang
- Department of Medical Affairs, The General Hospital of Northern Theater Command, Shenyang, China
| | - Longfei Li
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Guangming Cheng
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Wei Zhang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yufu Tang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunhui Wang
- Department of Hepatobiliary and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, China
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Cailleaux PE, Benarbia S, Allard G, Ureña-Torres P, Cohen-Solal M. A loosening prosthesis in a dialysis patient. Clin Kidney J 2020; 13:897-899. [PMID: 33123365 PMCID: PMC7577770 DOI: 10.1093/ckj/sfz078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/15/2019] [Indexed: 12/02/2022] Open
Abstract
A haemodialysis patient with periprosthetic fractures and a history of corticosteroid use was referred for assessment for bone mineral disorders. Mixed renal osteodystrophy was diagnosed following a bone biopsy. Correction for vitamin D insufficiency did not improve the clinical signs, which prompted a potential diagnosis of hypophosphataemic osteomalacia to be considered. No causes for hypophosphataemia were found, except for phosphate dietary restrictions. Phosphorus supplementation was administered, resulting in an upturn in bone biochemical and histological parameters and increased bone mineral density, thus confirming the diagnosis of hypophosphataemic osteomalacia due to low phosphate intake. Characteristic features related to this diagnosis are shown from three repeated bone biopsies performed during the course of patient follow-up.
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Affiliation(s)
- Pierre-Emmanuel Cailleaux
- INSERM U1132, Lariboisière Hospital, University of Paris-Diderot, Paris, France
- Louis-Mourier Hospital, Colombes, France
| | - Seddik Benarbia
- Department of Nephrology and Dialysis, AUB Santé, Quimper, France
| | | | - Pablo Ureña-Torres
- Department of Nephrology and Dialysis, AURA, Necker Hospital, University of Paris-Descartes, Paris, France
- Department of Renal Physiology, Necker Hospital, University of Paris-Descartes, Paris, France
| | - Martine Cohen-Solal
- INSERM U1132, Lariboisière Hospital, University of Paris-Diderot, Paris, France
- Department of Rheumatology, Lariboisière Hospital, University of Paris-Diderot, Paris, France
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Yu Y, Diao Z, Wang Y, Zhou P, Ding R, Liu W. Hemodialysis patients with low serum parathyroid hormone levels have a poorer prognosis than those with secondary hyperparathyroidism. Ther Adv Endocrinol Metab 2020; 11:2042018820958322. [PMID: 33014329 PMCID: PMC7513009 DOI: 10.1177/2042018820958322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Low serum parathyroid hormone (PTH) level and secondary hyperparathyroidism (SHPT) are very common in hemodialysis patients. However, the outcomes of patients with low PTH level or SHPT have not been carefully compared. Therefore, in the present study, we compared the outcomes of hemodialysis patients with low PTH level or SHPT. METHODS This was a multi-center, prospective, cohort study of 647 patients. The patients were recruited between 1 September 2016 and 1 January 2017 and followed until 31 December 2018. The participants were allocated to a low PTH group [serum intact PTH (iPTH) concentration < 60 pg/ml] and an SHPT group (iPTH ⩾ 600 pg/ml) according to their mean iPTH concentration across the entire observation period, and the outcomes were compared between these groups. The primary outcome was a composite outcome, which comprised all-cause mortality, non-fatal acute myocardial infarction, non-fatal acute stroke, and acute heart failure. RESULTS A total of 197 hemodialysis patients were allocated to the two groups: 87 with low PTH level and 110 with SHPT; 450 patients with time-averaged iPTH concentrations of 60-600 pg/ml were excluded. Kaplan-Meier analysis of the composite endpoint revealed a significant difference between participants with low PTH level and those with SHPT (p = 0.002). Cox multiple regression showed that participants with low PTH level had a higher incidence of the composite endpoint than those with SHPT (relative risk: 1.337, 95% confidence interval: 1.059-1.688). CONCLUSION Hemodialysis patients with low PTH level had a higher incidence of mortality and non-fatal cardiovascular events than those with SHPT, irrespective of whether the participants were age-matched.
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Affiliation(s)
- Yue Yu
- Department of Nephrology, Beijing Friendship
Hospital, Capital Medical University, Beijing, China
- Department of Nephrology, Fu Xing Hospital,
Capital Medical University, Beijing, China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship
Hospital, Capital Medical University, 95 Yong’An Road, Beijing 100050,
China
| | - Ying Wang
- Department of Nephrology, Fu Xing Hospital,
Capital Medical University, Beijing, China
| | - Peiyi Zhou
- Department of Nephrology, People’s Hospital of
Beijing Daxing District, Beijing, China
| | - Rui Ding
- Department of Nephrology, The Hospital of Shunyi
District Beijing, Beijing, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship
Hospital, Capital Medical University, 95 Yong’An Road, Beijing 100050,
China
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Fernández-Martín JL, Dusso A, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, Locatelli F, Górriz JL, Rutkowski B, Bos WJ, Tielemans C, Martin PY, Wüthrich RP, Pavlovic D, Benedik M, Rodríguez-Puyol D, Carrero JJ, Zoccali C, Cannata-Andía JB. Serum phosphate optimal timing and range associated with patients survival in haemodialysis: the COSMOS study. Nephrol Dial Transplant 2020; 34:673-681. [PMID: 29741651 DOI: 10.1093/ndt/gfy093] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. METHODS The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. RESULTS There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). CONCLUSION Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.
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Affiliation(s)
- José L Fernández-Martín
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Martínez-Camblor
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.,Facultad de Ciencias de la Educación, Universidad Autónoma de Chile, Santiago, Chile
| | - Maria P Dionisi
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | | | | | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy
| | - José L Górriz
- Department of Nephrology, Hospital Clinico Universitario, Valencia, Spain.,Department of Medicine, Health Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Boleslaw Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
| | - Willem-Jan Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Drasko Pavlovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Miha Benedik
- Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
| | - Diego Rodríguez-Puyol
- Department of Medicine, Universidad de Alcalá Nephrology Section and Research Unit Foundation, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain IRSIN REDinREN (Instituto de Salud Carlos III), Madrid, Spain
| | - Juan J Carrero
- Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Sweden
| | - Carmine Zoccali
- CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Italy
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
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Dang ZH, Tang C, Li GL, Luobu C, Qing D, Ma ZH, Qu JF, Suolang L, Liu LJ. Mineral and bone disorder in hemodialysis patients in the Tibetan Plateau: a multicenter cross-sectional study. Ren Fail 2019; 41:636-643. [PMID: 31269846 PMCID: PMC6610496 DOI: 10.1080/0886022x.2019.1635892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Mineral and bone disorder (MBD) in hemodialysis patients is associated with increased morbidity and mortality. Studies on the MBD status of hemodialysis patients at high altitudes are extremely limited. Methods: A total of 146 hemodialysis patients from 5 local hospitals across all districts with hemodialysis centers in the Tibetan Plateau were enrolled in this cross-sectional study. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), and intact parathyroid hormone (iPTH) levels, were measured. The achievement of MBD goals was compared with the achievement in the Dialysis Outcomes and Practice Study (DOPPS) 3, DOPPS 4 and a multicenter study of MBD in China. Factors associated with hyperphosphatemia were examined. Results: Altogether, 146 hemodialysis patients were recruited from the Tibetan Plateau. According to the K/DIGO guidelines, there were low achievement rates for serum Ca (40.4%), P (29.7%), and iPTH (47.1%). As for the (KDOQI) guidelines, the rates of achievement of defined targets were 38.4%, 33.7% and 16.4% for serum Ca, P and iPTH, respectively. The percentages of patients reaching the KDOQI targets for corrected Ca, P, and iPTH were significantly lower for Tibetan patients than the percentages found in DOPPS 3 (38.4% vs. 50.4%, 33.7% vs. 49.8%, and 16.4% vs. 31.4%, respectively, all p < .001) and DOPPS 4 (38.4% vs. 56.0%, 33.7% vs. 54.5%, and 16.4% vs. 35.3%, respectively, all p < .001). The percentage of patients reaching the KDOQI targets for iPTH was significantly lower in Tibet than in the plain areas of China (16.4% vs. 26.5%, p < .001). The proportion of patients with hypocalcemia was higher in Tibet than in the plain areas (44.5% vs. 19.4%, p < .001). The percentage of local patients with optimal P was significantly higher for patients with an activated vitamin D prescription than for patients without an activated vitamin D prescription (45.3% vs. 19.3%, p < .001). Age and the activated vitamin D prescription were independently associated with hyperphosphatemia. Conclusion: The MBD status of hemodialysis patients in Tibet is far from the ideal level. High altitude is one of the possible causes of the differences found, but not the principal one. It is necessary for medical staff in Tibet to improve the detection and treatment of MBD.
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Affiliation(s)
- Zong-Hui Dang
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Chen Tang
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Guo-Liang Li
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - Ciren Luobu
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
| | - De Qing
- Renal Division, The People's Hospital, Shannan, China
| | - Zhen-Hua Ma
- Renal Division, The People's Hospital, Shigatse, China
| | - Jing-Feng Qu
- Renal Division, Second People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - lamu Suolang
- Renal Division, The People's Hospital, Linzhi, China
| | - Li-Jun Liu
- Renal Division, The People’s Hospital of Tibet Autonomous Region, Lhasa, China
- Renal Division, Peking University First Hospital, Beijing, China
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Jin JJ, Zhang SL, Xu JS, Cui LW, Zhang HR, Bai YL. Prevalence of Chronic Kidney Disease-Mineral Bone Disorder in Hemodialysis Patients in Hebei, China. Chin Med J (Engl) 2018; 131:2749-2751. [PMID: 30425204 PMCID: PMC6247600 DOI: 10.4103/0366-6999.245264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jing-Jing Jin
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Sheng-Lei Zhang
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Jin-Sheng Xu
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Li-Wen Cui
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Hui-Ran Zhang
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Ya-Ling Bai
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
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Clinical Epidemiology of Mineral Bone Disorder Markers in Prevalent Hemodialysis Patients in the Xinjiang Uyghur Autonomous Region in China. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2516934. [PMID: 28299319 PMCID: PMC5337324 DOI: 10.1155/2017/2516934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/06/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023]
Abstract
We investigated the clinical epidemiology of mineral bone disorder markers in prevalent hemodialysis (HD) patients in Xinjiang, the largest province in China. Data were obtained from 59 hospitals. A total of 3725 patients tracked from January 1 to December 31, 2014, were enrolled. Serum calcium (Ca) levels, phosphorus (P) levels, and intact parathyroid hormone (iPTH) levels were analyzed. Serum Ca levels were lower compared to the International Dialysis Outcomes and Practice Patterns Study (DOPPS4) and the Chinese DOPPS. The hypercalcemia rate was similar to DOPPS4 and lower than in the Chinese DOPPS. Serum P levels were higher than in DOPPS4 and lower than those in the Chinese DOPPS. Hyperphosphatemia rates were higher than DOPPS4 and lower than Chinese DOPPS. Serum iPTH levels were higher than in DOPPS4 and the Chinese DOPPS. We demonstrated higher serum P and iPTH levels in Xinjiang HD patients than in the DOPPS4 and Chinese DOPPS. In contrast, serum Ca levels were lower than the other two studies. High hypocalcemia and hyperphosphatemia rates may suggest that HD services in Xinjiang are inadequate. A multidiscipline chronic kidney disease (CKD) care program needs to be established to improve chronic kidney disease-mineral and bone disorder (CKD-MBD) target achievement in Xinjiang.
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Elliott MJ, Booth SL, Hopman WM, Holden RM. Assessment of potential biomarkers of subclinical vitamin K deficiency in patients with end-stage kidney disease. Can J Kidney Health Dis 2014; 1:13. [PMID: 25780608 PMCID: PMC4349792 DOI: 10.1186/2054-3581-1-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/30/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A significant proportion of hemodialysis patients have functional, but modifiable, vitamin K deficiency. OBJECTIVE To determine the correlates of poor vitamin K status in hemodialysis patients. DESIGN Cross-sectional study. SETTING Hemodialysis units at Kingston General Hospital and its satellite centres, Ontario, Canada. PATIENTS Patients undergoing outpatient hemodialysis for end-stage kidney disease. MEASUREMENTS Serum concentrations of phylloquinone, undercarboxylated prothrombin, also known as protein induced by vitamin K absence or antagonism - factor II (PIVKA-II), and the percentage of undercarboxylated osteocalcin (%ucOC). METHODS Vitamin K status was determined in fasting blood samples of hemodialysis patients. Bivariate relationships were examined using parametric and non-parametric statistics as appropriate. Multivariable linear regression models were applied to identify predictors of vitamin K status. RESULTS Among 44 HD patients, criteria for subclinical vitamin K deficiency were met in 13.6% (phylloquinone < 0.4 nmol/L), 51% (%ucOC > 20%) and 90.9% (PIVKA-II > 2.0 nmol/L) of subjects. Phylloquinone levels were positively associated with total cholesterol, triglyceride levels and non-smoking status. Higher %ucOC was associated with increased calcium-phosphate product. Increased PIVKA-II levels were observed with advancing age, reduced dialysis adequacy, lower HDL and a history of coronary artery disease. There were no associations found among the individual biomarkers of vitamin K status. In a multi-variable model, triglycerides were the only significant predictor of phylloquinone levels, while increasing phosphate and decreasing PTH were independent predictors of %ucOC. PIVKA-II levels increased by 0.54 nmol/L for every 10-year increase in age. LIMITATIONS Observational study; small sample size. CONCLUSIONS A significant proportion of HD patients met criteria for subclinical vitamin K deficiency. Of the biomarkers measured, PIVKA-II may be superior given its independence of renal function or dyslipidemia, both of which may confound the other vitamin K biomarkers. Studies in patients with ESKD linking biomarkers of vitamin K status to important patient outcomes, including cardiovascular disease, nutritional status and mortality, are required in order to determine the optimal biomarker for evaluating vitamin K status in this particular population.
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Affiliation(s)
- Meghan J Elliott
- />Department of Medicine, University of Calgary, Calgary, AB Canada
- />Division of Nephrology, Foothills Medical Centre, 1403 29th Street NW, T2N 2T9 Calgary, AB Canada
| | - Sarah L Booth
- />Jean Mayer USDA Human Nutrition Research Center of Aging at Tufts University, Boston, MA USA
| | - Wilma M Hopman
- />Clinical Research Centre, Kingston General Hospital, Kingston, ON Canada
| | - Rachel M Holden
- />Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON Canada
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Chen J. Nutrition, Phosphorus, and Keto-Analogues in Hemodialysis Patients: A Chinese Perspective. J Ren Nutr 2013; 23:214-7. [DOI: 10.1053/j.jrn.2013.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 01/17/2013] [Indexed: 11/11/2022] Open
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11
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Paniagua R, Ventura MDJ, Ávila-Díaz M, Hinojosa-Heredia H, Méndez-Duran A, Cisneros A, Gómez AM, Cueto-Manzano A, Trinidad P, Obrador GT, García-López E, Lindholm B. Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients. Arch Med Res 2013; 44:229-34. [DOI: 10.1016/j.arcmed.2013.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022]
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12
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Wang M, You L, Li H, Lin Y, Zhang Z, Hao C, Chen J. Association of circulating fibroblast growth factor-23 with renal phosphate excretion among hemodialysis patients with residual renal function. Clin J Am Soc Nephrol 2013; 8:116-25. [PMID: 23085728 PMCID: PMC3531650 DOI: 10.2215/cjn.00230112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 09/20/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES High serum levels of fibroblast growth factor-23 (FGF-23) are associated with mortality in patients with ESRD, but whether it still acts as a phosphaturic factor is unknown. This study aimed to explore the role of circulating FGF-23 on urinary phosphate excretion and phosphate balance in maintenance hemodialysis (MHD) patients with residual renal function (RRF). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS There were 134 MHD patients enrolled in this cross-sectional study from June to July 2010. Demographics, laboratory data, and excretion capacity of phosphate were recorded. Multivariable linear regression was used to analyze the relationship of serum phosphate and the tubular reabsorption rate of phosphate with other factors. RESULTS The median age of the patients was 61.0 years and 47.8% were male. Thirty percent of the patients had high urinary output (>200 ml/d) accompanied by lower serum levels of phosphate, calcium, intact parathyroid hormone, and FGF-23 compared with those with low urine output (≤200 ml/d). The independent predictors of serum phosphate were normalized protein nitrogen appearance, intact parathyroid hormone, and FGF-23 in the low urine output group and female sex and GFR in the high urine output group. The tubular reabsorption rate of phosphate decreased to 50% of the normal level in patients with RRF. Elevated circulating FGF-23 was significantly associated with lower tubular phosphate reabsorption after adjusting for GFR. CONCLUSIONS RRF is associated with significant capacity to excrete phosphate in MHD patients and high levels of serum FGF-23 may promote phosphate excretion by remnant nephrons.
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Affiliation(s)
| | - Li You
- Divisions of Nephrology and
| | | | - Yong Lin
- Clinical Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhijie Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China; and
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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13
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Kong X, Zhang L, Zhang L, Chen N, Gu Y, Yu X, Liu W, Chen J, Peng L, Yuan W, Wu H, Chen W, Fan M, He L, Ding F, Chen X, Xiong Z, Zhang J, Jia Q, Shi W, Xing C, Tang X, Hou F, Shu G, Mei C, Wang L, Xu D, Ni Z, Zuo L, Wang M, Wang H. Mineral and bone disorder in Chinese dialysis patients: a multicenter study. BMC Nephrol 2012; 13:116. [PMID: 22994525 PMCID: PMC3507668 DOI: 10.1186/1471-2369-13-116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 09/14/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mineral and bone disorder (MBD) in patients with chronic kidney disease is associated with increased morbidity and mortality. Studies regarding the status of MBD treatment in developing countries, especially in Chinese dialysis patients are extremely limited. METHODS A cross-sectional study of 1711 haemodialysis (HD) patients and 363 peritoneal dialysis (PD) patients were enrolled. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH) were analyzed. The achievement of MBD targets was compared with the results from the Dialysis Outcomes and Practice Study (DOPPS) 3 and DOPPS 4. Factors associated with hyperphosphatemia were examined. RESULTS Total 2074 dialysis patients from 28 hospitals were involved in this study. Only 38.5%, 39.6% and 26.6% of them met the Kidney Disease Outcomes Quality Initiative (K/DOQI) defined targets for serum P, Ca and iPTH levels. Serum P and Ca levels were statistically higher (P < 0.05) in the HD patients compared with those of PD patients, which was (6.3 ± 2.1) mg/dL vs (5.7 ± 2.0) mg/dL and (9.3 ± 1.1) mg/dL vs (9.2 ± 1.1) mg/dL, respectively. Serum iPTH level were statistically higher in the PD patients compared with those of HD patients (P = 0.03). The percentage of patients reached the K/DOQI targets for P (37.6% vs 49.8% vs 54.5%, P < 0.01), Ca (38.6% vs 50.4% vs 56.0%, P < 0.01) and iPTH (26.5% vs 31.4% vs 32.1%, P < 0.01) were lower among HD patients, compared with the data from DOPPS 3 and DOPPS 4. The percentage of patients with serum phosphorus level above 5.5 mg/dL was 57.4% in HD patients and 47.4% in PD patients. Age, dialysis patterns and region of residency were independently associated with hyperphosphatemia. CONCLUSIONS Status of MBD is sub-optimal among Chinese patients receiving dialysis. The issue of hyperphosphatemia is prominent and needs further attention.
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Affiliation(s)
- Xianglei Kong
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Ling Zhang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yong Gu
- Renal Division, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xueqing Yu
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianghua Chen
- Kidney Diseases Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liren Peng
- Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Weijie Yuan
- Department of Nephrology, Shanghai First People s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hua Wu
- Department of Nephrology, Beijing Hospital, Beijing, China
| | - Wei Chen
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Minhua Fan
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Liqun He
- Department of Nephrology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Ding
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiangmei Chen
- Department of Nephrology, The General Hospital of the People's Liberation Army, Beijing, China
| | - Zuying Xiong
- Renal Division, Hospital Peking of Shenzhen, Shenzhen, China
| | - Jinyuan Zhang
- Department of Nephrology, The 455th Hospital of PLA, Shanghai, China
| | - Qiang Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Shi
- Department of Nephrology, Guangdong General Hospital, Guangzhou, China
| | - Changying Xing
- Renal Division, Jiangsu Provincial Hospital, Nanjing, China
| | - Xiaoling Tang
- Department of internal medicine, Shantou Central Hospital, Shantou, China
| | - Fanfan Hou
- Department of Nephrology, Nanfang Hospital, The Southern Medical University, Guangzhou, China
| | - Guiyang Shu
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Changlin Mei
- Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Nephrology, Sichuan Provincial People’ s Hospital, Chengdu, China
| | - Dongmei Xu
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhaohui Ni
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zuo
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Mei Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
- Institute of Nephrology and Division of Nephrology, and Key Laboratory of Ministry of Health, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Haiyan Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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Wang M, Li H, Liao H, Yu Y, You L, Zhu J, Huang B, Yuan L, Hao C, Chen J. Phosphate removal model: an observational study of low-flux dialyzers in conventional hemodialysis therapy. Hemodial Int 2012; 16:363-76. [PMID: 22360645 DOI: 10.1111/j.1542-4758.2012.00678.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Precise assessing phosphate removal by hemodialysis (HD) is important to improve phosphate control in patients on maintenance HD. We reported a simple noninvasive model to estimate phosphate removal within a 4-hour HD. One hundred sixty-five patients who underwent HD 4 hours per session using low-flux dialyzers made of polysulfone (1.2 m(2)) or triacetate (1.3 m(2)) were enrolled. Blood flows varied from 180 to 300 mL/min. Effluent dialysate samples were collected during the 4-hour HD treatment to measure the total phosphate removal. Predialysis levels of serum phosphate, potassium, hematocrit, intact parathyroid hormone, total carbon dioxide (TCO(2)), alkaline phosphatase, clinical and dialysis characteristics were obtained. One hundred thirty-five observations were randomly selected for model building and the remaining 30 for model validation. Total amount of phosphate removal within the 4-hour HD was mostly 15-30 mmol. A primary model (model 1) predicting total phosphate removal was Tpo(4) = 79.6 × C(45) (mmol/L) - 0.023 × age (years) + 0.065 × weight (kg) - 0.12 × TCO(2) (mmol/L) + 0.05 × clearance (mL/min) - 3.44, where C(45) was phosphate concentration in spent dialysate measured at the 45 minute of HD and clearance was phosphate clearance of dialyzer in vitro conditions offered by manufacturer's data sheet. Since the parameter TCO(2) needed serum sample for measurement, we further derived a noninvasive model (model 2):Tpo(4) = 80.3 × C(45) - 0.024 × age + 0.07 × weight + 0.06 × clearance - 8.14. Coefficient of determination, root mean square error, and residual plots showed the appropriateness of two models. Model validation further suggested good and similar predictive ability of them. This study derived a noninvasive model to predict phosphate removal. It applies to patients treated by 4-hour HD under similar conditions.
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Affiliation(s)
- Mengjing Wang
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Kerr PG. Dialysis: Nocturnal hemodialysis--should we still provide this therapy? Nat Rev Nephrol 2011; 7:611-2. [PMID: 21931336 DOI: 10.1038/nrneph.2011.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kerr PG. International differences in hemodialysis delivery and their influence on outcomes. Am J Kidney Dis 2011; 58:461-70. [PMID: 21783291 DOI: 10.1053/j.ajkd.2011.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 03/04/2011] [Indexed: 11/11/2022]
Abstract
There are many variations in the delivery of hemodialysis. These variations include components of conventional dialysis, such as membrane type, dialysis dose, and session duration. In addition, alternative approaches to dialysis, such as hemodiafiltration, nocturnal hemodialysis, and short daily hemodialysis, also may be considered. For some of these practice variations, data exist to support one approach over another (eg, fistulas rather than grafts and catheters), but for many, no such data exist. Very few practice variations have been examined in randomized trials, and we are reliant predominantly on observational data. This review examines some practice variations in hemodialysis delivery, attempting to highlight which of these may be appropriate to consider when optimizing dialysis delivery in the clinic.
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Affiliation(s)
- Peter G Kerr
- Department of Nephrology, Monash Medical Centre and Monash University, Clayton, Victoria, Australia.
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Goldsmith DJA, Cunningham J. Mineral metabolism and vitamin D in chronic kidney disease--more questions than answers. Nat Rev Nephrol 2011; 7:341-6. [PMID: 21537350 DOI: 10.1038/nrneph.2011.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of total and cardiovascular morbidity and mortality. The underlying pathophysiology of this association remains largely unexplained and there is currently no clear interventional pathway. Emphasis has been placed on measuring serum levels of calcium, phosphate and parathyroid hormone (PTH) to monitor disease progression, driven by the assumption that achieving values within the 'normal' range will translate into improved outcomes. Retrospective studies have provided a body of evidence that abnormal levels of mineral biomarkers, and phosphate in particular, are associated with clinical events. Disturbances in vitamin D metabolism are also likely to contribute to the pathophysiology of CKD. Designing studies that yield useful information has proved to be difficult, partly owing to conceptual and financial limitations, but also because of the tight interdependency of calcium, phosphate and PTH, and the potential impact of vitamin D on these mineral metabolites. An intervention that perturbs any one of these factors is likely to exert effects on the others, making isolation of the individual variables almost impossible. However, some therapies in current use have the potential to act as probes to answer questions relating to the association between mineral biomarkers and outcomes in CKD.
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Affiliation(s)
- David J A Goldsmith
- Renal and Transplantation Department, 6th Floor, Borough Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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