Kidney Week

Abstract: TH-PO161

International Variations in Serum PTH and Calcium Levels and Their Mortality Associations in Peritoneal Dialysis Patients: Results from PDOPPS

Session Information

• Bone and Mineral Metabolism: CKD-MBD Updates
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Nitta, Kosaku, Tokyo Joshi Ika Daigaku Igakubu Daigakuin Igaku Kenkyuka, Shinjuku-ku, Tokyo, Japan

Kosaku Nitta,

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber,

• Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Angelo Karaboyas,

• Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

David W. Johnson,

• Kanjanabuch, Talerngsak, Chulalongkorn University, Bangkok, Bangkok, Thailand

Talerngsak Kanjanabuch,

• Kim, Yong-Lim, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Yong-Lim Kim,

• Lambie, Mark, Keele University, Keele, Staffordshire, United Kingdom

Mark Lambie,

• Shen, Jenny I., The Lundquist Institute, Torrance, California, United States

Jenny I. Shen,

• Naljayan, Mihran V., DaVita Inc, Denver, Colorado, United States

Mihran V. Naljayan,

• Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Roberto Pecoits-Filho,

• Robinson, Bruce M., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Perl, Jeffrey, University of Toronto, Toronto, Ontario, Canada

Jeffrey Perl,

• Kawanishi, Hideki, Tsuchiya Sogo Byoin, Hiroshima, Japan

Hideki Kawanishi,

Background

Mineral bone disorder (MBD) in chronic kidney disease (CKD) is associated with high symptom burden, fractures, vascular calcification, cardiovascular disease, and increased morbidity and mortality. CKD-MBD studies have been limited in peritoneal dialysis (PD) patients. Here, we describe calcium and parathyroid hormone (PTH) control, and mortality associations in PD patients.

Methods

We used data from 8 countries [Australia and New Zealand (A/NZ), Canada, Japan, Thailand, South Korea, United Kingdom, United States (US)] participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS; 2014-2022) among patients receiving PD for >3 months. We analyzed the association of baseline PTH and albumin-adjusted calcium (calcium^Alb) with all-cause mortality using Cox regression, adjusted for potential confounders.

Results

Mean age ranged from 54.6 yrs in South Korea to 63.5 yrs in Japan. PTH and serum calcium^Alb were measured at baseline in 12,642 and 14,244 patients, respectively. Median PTH ranged from 161 (Japan) to 363 pg/mL (US); mean calcium^Alb ranged from 9.1 (South Korea, US) to 9.8 mg/dL (A/NZ). The PTH/mortality relationship was U-shaped with lowest risk at PTH 300-599 pg/mL. Mortality was nearly 20% higher at serum calcium^Alb 9.6+ mg/dL vs 8.4-<9.6 mg/dL.

Conclusion

A large proportion of PD patients in this multi-national study have Ca and/or PTH levels in ranges associated with substantially higher mortality. These observations point to the need to substantially improve MBD management in PD to optimize patient outcomes.

Funding

• Commercial Support – Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details see https://www.dopps.org/AboutUs/Support.aspx.