Association of serum mineral parameters with mortality in hemodialysis patients: Data from the korean end-stage renal disease registry

Yunmi Kim, Kyung Don Yoo, Hyo Jin Kim, Junga Koh, Yeonsil Yu, Young Joo Kwon, Gheun Ho Kim, Tae Hyun Yoo, Joongyub Lee, Dong Chan Jin, Bum Soon Choi, Yeong Hoon Kim, Kook Hwan Oh

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Abstract

Background: We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients. Methods: Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed. Results: Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; P = 0.003). Conclusion: In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.

Original languageEnglish
Pages (from-to)266-276
Number of pages11
JournalKidney Research and Clinical Practice
Volume37
Issue number3
DOIs
Publication statusPublished - 2018 Sep

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All Science Journal Classification (ASJC) codes

  • Nephrology
  • Urology

Cite this

Kim, Y., Yoo, K. D., Kim, H. J., Koh, J., Yu, Y., Kwon, Y. J., Kim, G. H., Yoo, T. H., Lee, J., Jin, D. C., Choi, B. S., Kim, Y. H., & Oh, K. H. (2018). Association of serum mineral parameters with mortality in hemodialysis patients: Data from the korean end-stage renal disease registry. Kidney Research and Clinical Practice, 37(3), 266-276. https://doi.org/10.23876/j.krcp.2018.37.3.266