Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients

Sul A. Lee, Mi Jung Lee, Geun Woo Ryu, Jong Hyun Jhee, Hyung Woo Kim, Seohyun Park, Su Young Jung, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Shin Wook Kang, Tae Hyun Yoo

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Abstract

Summary: Abnormal bone dynamics is a major risk factor for cardiovascular disease in patients with chronic kidney disease. The level of serum intact parathyroid hormone (iPTH) is widely used as a bone dynamic marker. We investigated the effect of the mean level of serum iPTH on overall mortality and cardiovascular outcomes in incident dialysis patients. Purpose: Chronic kidney disease–mineral bone disorder (CKD–MBD) is a major risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). CKD–MBD is classified as low- or high-turnover bone disease according to the bone dynamics; both are related to vascular calcification in ESRD. To evaluate the prognostic value of abnormal serum parathyroid hormone (PTH) levels on ESRD patients, we investigated the effects of time-averaged serum intact PTH (TA-iPTH) levels on overall mortality and major adverse cardiac and cerebrovascular events (MACCEs) in incident dialysis patients. Methods: Four hundred thirteen patients who started dialysis between January 2009 and September 2013 at Yonsei University Health System were enrolled. The patients were divided into three groups according to TA-iPTH levels during the 12 months after the initiation of dialysis: group 1, <65 pg/ml; group 2, 65–300 pg/ml; and group 3, >300 pg/ml. Cox regression analyses were performed to determine the prognostic value of TA-iPTH for overall mortality and MACCEs. Results: The mean age of the patients was 57 ± 15 years, and 222 patients (54 %) were men. During the median follow-up of 40.8 ± 29.3 months, 49 patients (12 %) died, and MACCEs occurred in 55 patients (13 %). The multivariate Cox regression analyses demonstrated that a low TA-iPTH level was an independent risk factor for both overall mortality (group 2 as reference; group 1: hazard ratio (HR) = 2.06, 95 % confidence interval (CI) = 1.11–3.83, P = 0.023) and MACCEs (HR = 1.82, 95 % CI = 1.04–3.20, P = 0.036) in incident dialysis patients after adjustment for confounding factors. Conclusion: Low serum TA-iPTH is a useful clinical marker of both overall mortality and MACCEs in patients undergoing incident dialysis, mediated by vascular calcification.

Original languageEnglish
Pages (from-to)2717-2726
Number of pages10
JournalOsteoporosis International
Volume27
Issue number9
DOIs
Publication statusPublished - 2016 Sep 1

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Parathyroid Hormone
Dialysis
Mortality
Serum
Bone and Bones
Chronic Kidney Failure
Vascular Calcification
Cardiovascular Diseases
Regression Analysis
Confidence Intervals
Kidney
Bone Diseases
Chronic Renal Insufficiency
Biomarkers

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

Cite this

Lee, Sul A. ; Lee, Mi Jung ; Ryu, Geun Woo ; Jhee, Jong Hyun ; Kim, Hyung Woo ; Park, Seohyun ; Jung, Su Young ; Oh, Hyung Jung ; Park, Jung Tak ; Han, Seung Hyeok ; Kang, Shin Wook ; Yoo, Tae Hyun. / Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients. In: Osteoporosis International. 2016 ; Vol. 27, No. 9. pp. 2717-2726.
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title = "Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients",
abstract = "Summary: Abnormal bone dynamics is a major risk factor for cardiovascular disease in patients with chronic kidney disease. The level of serum intact parathyroid hormone (iPTH) is widely used as a bone dynamic marker. We investigated the effect of the mean level of serum iPTH on overall mortality and cardiovascular outcomes in incident dialysis patients. Purpose: Chronic kidney disease–mineral bone disorder (CKD–MBD) is a major risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). CKD–MBD is classified as low- or high-turnover bone disease according to the bone dynamics; both are related to vascular calcification in ESRD. To evaluate the prognostic value of abnormal serum parathyroid hormone (PTH) levels on ESRD patients, we investigated the effects of time-averaged serum intact PTH (TA-iPTH) levels on overall mortality and major adverse cardiac and cerebrovascular events (MACCEs) in incident dialysis patients. Methods: Four hundred thirteen patients who started dialysis between January 2009 and September 2013 at Yonsei University Health System were enrolled. The patients were divided into three groups according to TA-iPTH levels during the 12 months after the initiation of dialysis: group 1, <65 pg/ml; group 2, 65–300 pg/ml; and group 3, >300 pg/ml. Cox regression analyses were performed to determine the prognostic value of TA-iPTH for overall mortality and MACCEs. Results: The mean age of the patients was 57 ± 15 years, and 222 patients (54 {\%}) were men. During the median follow-up of 40.8 ± 29.3 months, 49 patients (12 {\%}) died, and MACCEs occurred in 55 patients (13 {\%}). The multivariate Cox regression analyses demonstrated that a low TA-iPTH level was an independent risk factor for both overall mortality (group 2 as reference; group 1: hazard ratio (HR) = 2.06, 95 {\%} confidence interval (CI) = 1.11–3.83, P = 0.023) and MACCEs (HR = 1.82, 95 {\%} CI = 1.04–3.20, P = 0.036) in incident dialysis patients after adjustment for confounding factors. Conclusion: Low serum TA-iPTH is a useful clinical marker of both overall mortality and MACCEs in patients undergoing incident dialysis, mediated by vascular calcification.",
author = "Lee, {Sul A.} and Lee, {Mi Jung} and Ryu, {Geun Woo} and Jhee, {Jong Hyun} and Kim, {Hyung Woo} and Seohyun Park and Jung, {Su Young} and Oh, {Hyung Jung} and Park, {Jung Tak} and Han, {Seung Hyeok} and Kang, {Shin Wook} and Yoo, {Tae Hyun}",
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Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients. / Lee, Sul A.; Lee, Mi Jung; Ryu, Geun Woo; Jhee, Jong Hyun; Kim, Hyung Woo; Park, Seohyun; Jung, Su Young; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Kang, Shin Wook; Yoo, Tae Hyun.

In: Osteoporosis International, Vol. 27, No. 9, 01.09.2016, p. 2717-2726.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients

AU - Lee, Sul A.

AU - Lee, Mi Jung

AU - Ryu, Geun Woo

AU - Jhee, Jong Hyun

AU - Kim, Hyung Woo

AU - Park, Seohyun

AU - Jung, Su Young

AU - Oh, Hyung Jung

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Kang, Shin Wook

AU - Yoo, Tae Hyun

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Summary: Abnormal bone dynamics is a major risk factor for cardiovascular disease in patients with chronic kidney disease. The level of serum intact parathyroid hormone (iPTH) is widely used as a bone dynamic marker. We investigated the effect of the mean level of serum iPTH on overall mortality and cardiovascular outcomes in incident dialysis patients. Purpose: Chronic kidney disease–mineral bone disorder (CKD–MBD) is a major risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). CKD–MBD is classified as low- or high-turnover bone disease according to the bone dynamics; both are related to vascular calcification in ESRD. To evaluate the prognostic value of abnormal serum parathyroid hormone (PTH) levels on ESRD patients, we investigated the effects of time-averaged serum intact PTH (TA-iPTH) levels on overall mortality and major adverse cardiac and cerebrovascular events (MACCEs) in incident dialysis patients. Methods: Four hundred thirteen patients who started dialysis between January 2009 and September 2013 at Yonsei University Health System were enrolled. The patients were divided into three groups according to TA-iPTH levels during the 12 months after the initiation of dialysis: group 1, <65 pg/ml; group 2, 65–300 pg/ml; and group 3, >300 pg/ml. Cox regression analyses were performed to determine the prognostic value of TA-iPTH for overall mortality and MACCEs. Results: The mean age of the patients was 57 ± 15 years, and 222 patients (54 %) were men. During the median follow-up of 40.8 ± 29.3 months, 49 patients (12 %) died, and MACCEs occurred in 55 patients (13 %). The multivariate Cox regression analyses demonstrated that a low TA-iPTH level was an independent risk factor for both overall mortality (group 2 as reference; group 1: hazard ratio (HR) = 2.06, 95 % confidence interval (CI) = 1.11–3.83, P = 0.023) and MACCEs (HR = 1.82, 95 % CI = 1.04–3.20, P = 0.036) in incident dialysis patients after adjustment for confounding factors. Conclusion: Low serum TA-iPTH is a useful clinical marker of both overall mortality and MACCEs in patients undergoing incident dialysis, mediated by vascular calcification.

AB - Summary: Abnormal bone dynamics is a major risk factor for cardiovascular disease in patients with chronic kidney disease. The level of serum intact parathyroid hormone (iPTH) is widely used as a bone dynamic marker. We investigated the effect of the mean level of serum iPTH on overall mortality and cardiovascular outcomes in incident dialysis patients. Purpose: Chronic kidney disease–mineral bone disorder (CKD–MBD) is a major risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). CKD–MBD is classified as low- or high-turnover bone disease according to the bone dynamics; both are related to vascular calcification in ESRD. To evaluate the prognostic value of abnormal serum parathyroid hormone (PTH) levels on ESRD patients, we investigated the effects of time-averaged serum intact PTH (TA-iPTH) levels on overall mortality and major adverse cardiac and cerebrovascular events (MACCEs) in incident dialysis patients. Methods: Four hundred thirteen patients who started dialysis between January 2009 and September 2013 at Yonsei University Health System were enrolled. The patients were divided into three groups according to TA-iPTH levels during the 12 months after the initiation of dialysis: group 1, <65 pg/ml; group 2, 65–300 pg/ml; and group 3, >300 pg/ml. Cox regression analyses were performed to determine the prognostic value of TA-iPTH for overall mortality and MACCEs. Results: The mean age of the patients was 57 ± 15 years, and 222 patients (54 %) were men. During the median follow-up of 40.8 ± 29.3 months, 49 patients (12 %) died, and MACCEs occurred in 55 patients (13 %). The multivariate Cox regression analyses demonstrated that a low TA-iPTH level was an independent risk factor for both overall mortality (group 2 as reference; group 1: hazard ratio (HR) = 2.06, 95 % confidence interval (CI) = 1.11–3.83, P = 0.023) and MACCEs (HR = 1.82, 95 % CI = 1.04–3.20, P = 0.036) in incident dialysis patients after adjustment for confounding factors. Conclusion: Low serum TA-iPTH is a useful clinical marker of both overall mortality and MACCEs in patients undergoing incident dialysis, mediated by vascular calcification.

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U2 - 10.1007/s00198-016-3636-1

DO - 10.1007/s00198-016-3636-1

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JO - Osteoporosis International

JF - Osteoporosis International

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ER -