TY - JOUR
T1 - Association between CKD-MBD and mortality in older patients with advanced CKD - results from the EQUAL study
AU - Magagnoli, Lorenza
AU - Cozzolino, Mario
AU - Caskey, Fergus J.
AU - Evans, Marie
AU - Torino, Claudia
AU - Porto, Gaetana
AU - Szymczak, Maciej
AU - Krajewska, Magdalena
AU - Drechsler, Christiane
AU - Stenvinkel, Peter
AU - Pippias, Maria
AU - Dekker, Friedo W.
AU - de Rooij, Esther N. M.
AU - Wanner, Christoph
AU - the EQUAL study investigators
AU - Chesnaye, Nicholas C.
AU - Jager, Kitty J.
N1 - Funding Information: Main funding was received from the European Renal Association (ERA), and contributions from the Swedish Medical Association (SLS), the Stockholm County Council ALF Medicine and Centre for Innovative research (CIMED), the Italian Society of Nephrology (SIN-Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany and the National Institute for Health Research (NIHR) in the UK. Publisher Copyright: © 2023 Oxford University Press. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background. Chronic kidney disease–mineral and bone disorder (CKD-MBD) is a common complication of CKD; it is associated with higher mortality in dialysis patients, while its impact in non-dialysis patients remains mostly unknown. We investigated the associations between parathyroid hormone (PTH), phosphate and calcium (and their interactions), and all-cause, cardiovascular (CV) and non-CV mortality in older non-dialysis patients with advanced CKD. Methods. We used data from the European Quality study, which includes patients aged ≥65 years with estimated glomerular filtration rate ≤20 mL/min/1.73 m2 from six European countries. Sequentially adjusted Cox models were used to assess the association between baseline and time-dependent CKD-MBD biomarkers and all-cause, CV and non-CV mortality. Effect modification between biomarkers was also assessed. Results. In 1294 patients, the prevalence of CKD-MBD at baseline was 94%. Both PTH [adjusted hazard ratio (aHR) 1.12, 95% confidence interval (CI) 1.03–1.23, P = .01] and phosphate (aHR 1.35, 95% CI 1.00–1.84, P = .05), but not calcium (aHR 1.11, 95% CI 0.57–2.17, P = .76), were associated with all-cause mortality. Calcium was not independently associated with mortality, but modified the effect of phosphate, with the highest mortality risk found in patients with both hypercalcemia and hyperphosphatemia. PTH level was associated with CV mortality, but not with non-CV mortality, whereas phosphate was associated with both CV and non-CV mortality in most models. Conclusions. CKD-MBD is very common in older non-dialysis patients with advanced CKD. PTH and phosphate are independently associated with all-cause mortality in this population. While PTH level is only associated with CV mortality, phosphate seems to be associated with both CV and non-CV mortality.
AB - Background. Chronic kidney disease–mineral and bone disorder (CKD-MBD) is a common complication of CKD; it is associated with higher mortality in dialysis patients, while its impact in non-dialysis patients remains mostly unknown. We investigated the associations between parathyroid hormone (PTH), phosphate and calcium (and their interactions), and all-cause, cardiovascular (CV) and non-CV mortality in older non-dialysis patients with advanced CKD. Methods. We used data from the European Quality study, which includes patients aged ≥65 years with estimated glomerular filtration rate ≤20 mL/min/1.73 m2 from six European countries. Sequentially adjusted Cox models were used to assess the association between baseline and time-dependent CKD-MBD biomarkers and all-cause, CV and non-CV mortality. Effect modification between biomarkers was also assessed. Results. In 1294 patients, the prevalence of CKD-MBD at baseline was 94%. Both PTH [adjusted hazard ratio (aHR) 1.12, 95% confidence interval (CI) 1.03–1.23, P = .01] and phosphate (aHR 1.35, 95% CI 1.00–1.84, P = .05), but not calcium (aHR 1.11, 95% CI 0.57–2.17, P = .76), were associated with all-cause mortality. Calcium was not independently associated with mortality, but modified the effect of phosphate, with the highest mortality risk found in patients with both hypercalcemia and hyperphosphatemia. PTH level was associated with CV mortality, but not with non-CV mortality, whereas phosphate was associated with both CV and non-CV mortality in most models. Conclusions. CKD-MBD is very common in older non-dialysis patients with advanced CKD. PTH and phosphate are independently associated with all-cause mortality in this population. While PTH level is only associated with CV mortality, phosphate seems to be associated with both CV and non-CV mortality.
KW - CKD-MBD
KW - PTH
KW - cardiovascular
KW - mineral
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85177227217&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ndt/gfad100
DO - https://doi.org/10.1093/ndt/gfad100
M3 - Article
C2 - 37230954
SN - 0931-0509
VL - 38
SP - 2562
EP - 2575
JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
IS - 11
ER -