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Association of mineral metabolism factors with all‐cause and cardiovascular mortality in hemodialysis patients: The Japan dialysis outcomes and practice patterns study
Author(s) -
KIMATA Naoki,
ALBERT Justin M.,
AKIBA Takashi,
YAMAZAKI Shin,
KAWAGUCHI Yoshindo,
FUKUHARA Shunichi,
AKIZAWA Tadao,
SAITO Akira,
ASANO Yasushi,
KUROKAWA Kiyoshi,
PISONI Ronald L.,
PORT Friedrich K.
Publication year - 2007
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2007.00190.x
Subject(s) - medicine , dialysis , hemodialysis , phosphorus , kidney disease , relative risk , calcium , endocrinology , physiology , gastroenterology , confidence interval , chemistry , organic chemistry
Abnormalities in mineral metabolism have been linked to mortality in hemodialysis (HD) patients. We postulated that these abnormalities would have a particularly large deleterious impact on deaths due to cardiovascular causes in Japan. This study describes the recent status of abnormal mineral metabolism, significant predictors, and potential consequences in the Dialysis Outcomes and Practice Patterns Study (DOPPS), Phases 1 and 2, in Japan. Major predictor variables were patient demographics, comorbidities, and laboratory markers of mineral metabolism such as albumin‐adjusted serum calcium (calciumAlb), phosphorus, and intact PTH (iPTH). In a cross section of 3973 Japanese HD patients in DOPPS I and II, a large faction had laboratory values outside of the recommended Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline range for serum concentrations of phosphorus (51% of patients above upper target range), calciumAlb (43.7% above), calcium‐phosphorus (Ca × P) product (41.1% above), and iPTH (18.6% above). All‐cause mortality was significantly and independently associated with calciumAlb (relative risk [RR]=1.22 per 1 mg/dL, p=0.0005) and iPTH (RR=1.04 per 100 pg/mL, p=0.04). Cardiovascular mortality was significantly associated with calciumAlb (RR=1.28, p=0.02), phosphorus (RR=1.13 per 1 mg/dL, p=0.008), Ca × P product (RR=1.07 per 2 mg 2 /dL 2 , p=0.002), and PTH (RR=1.08, p=0.0001). This study expands our understanding of the relationship between altered mineral metabolism and mortality outcomes, showing slightly stronger associations with cardiovascular causes than observed for all‐cause mortality. These findings have important therapeutic implications for Japanese HD patients.