Open AccessPrognosis and determinants of serum PTH changes over time in 1-5 CKD stage patients followed in tertiary care
Author(s) -
Silvio Borrelli,
Paolo Chiodini,
Luca De Nicola,
Roberto Minutolo,
Michele Provenzano,
Carlo Garofalo,
Giuseppe Remuzzi,
Claudio Ronco,
Mario Cozzolino,
Carlo Manno,
Anna Maria Costanzo,
Giuliana Gualberti,
Giuseppe Conte
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0202417
Subject(s) - medicine , kidney disease , quartile , proportional hazards model , nephrology , end stage renal disease , cohort , gastroenterology , endocrinology , urology , hemodialysis , confidence interval
International Guidelines for mineral bone disorders recommend that in Non Dialytic-Chronic Kidney Disease (ND-CKD) clinical decisions should be based on the trend of serum PTH changes over time rather than on a single value. However, the prognostic impact of these changes in ND-CKD patients remains unknown. We performed a multicenter cohort study in ND-CKD patients (stage 1–5) followed for 36 months in 24 Italian Nephrology Units. PTH changes (ΔPTH) were defined as the absolute differences between all available PTH measurements following the first control and basal value. Primary endpoint in this subanalysis was renal death (End-Stage Renal Disease (ESRD) or all-causes death before ESRD). Association between renal death and ΔPTH was assessed by time-dependent Cox model for repeated measurements. Out of the original cohort (N = 884), we selected 543 patients (66.3±15.4 ys, 58.4% males) with at least two serum PTH measurements. At baseline, eGFR was 36 (IQR: 22.4–56.8) mL/min/1.73m 2 and serum PTH 46 (IQR: 28–81) pg/mL. ΔPTH was in median 0 (IQR:-18/18) pg/mL. Basal predictors of longitudinal PTH increments were higher serum phosphate, more advanced CKD stages and lower serum PTH. Fully adjusted Cox model with ΔPTH quartiles as discrete time-dependent covariate showed a significant risk of renal death in the highest quartile (HR: 1.91; 95%CI:1.08–3.38; P = 0.026). Considering ΔPTH , as continuous time-dependent variable, (HR:1.02; 95%C.I.: 1.01–1.04; P = 0.004), risk of renal death progressively rose as ΔPTH increased. An increment in serum PTH over time is associated with a worse prognosis in ND-CKD patients, independently from baseline or any absolute concentration of serum PTH and phosphate.