Kidney Week

Abstract: PUB097

PTH Variability Is Associated with Increased Risk of Mortality in Patients on Hemodialysis

Session Information

• Publication Only

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Kato, Tadashi, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Shinagawa, Japan

Tadashi Kato, MD, PhD

• Yoshida, Kiryu, Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan

Kiryu Yoshida, MD, PhD

• Saito, Tomohiro, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Shinagawa, Japan

Tomohiro Saito, MD, PhD

• Kato, Noriyuki, Saiyu Clinic, Koshigaya, Saitama, Japan

Noriyuki Kato, PhD

• Mizobuchi, Masahide, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Shinagawa, Japan

Masahide Mizobuchi, MD, PhD

• Ogata, Hiroaki, Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan

Hiroaki Ogata, MD, PhD

• Koiwa, Fumihiko, Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan

Fumihiko Koiwa, MD, PhD

• Honda, Hirokazu, Division of Nephrology, Department of Medicine, Showa University School of Medicine, Shinagawa, Japan

Hirokazu Honda, MD, PhD

Background

Elevated parathyroid hormone (PTH) levels are associated with cardiovascular events, bone disease, and mortality in patients undergoing maintenance hemodialysis. PTH levels widely vary in hemodialysis patients, but it is unclear PTH variability would affect mortality.

Methods

A total of 331 maintenance hemodialysis patients at Saiyu Clinic who had measured PTH at least twice a year were included in the study. The association between all-cause mortality, cardiovascular events, and fractures was evaluated in patients with PTH concentrations always between 60 and 240 (Time in Terget range (TTR) 100%) and those without PTH concentrations (TTR < 100%).

Results

There were 122 patients with TTR 100% and 209 patients with TTR < 100%; over the 4-year observation period, patients with TTR 100% had significantly decreased all-cause mortality than those with TTR < 100% (HR 1.68, 95% CI 1.11-2.53) (Figure A). Subgroup analysis by the presence or absence of pharmacological intervention showed no difference in all-cause mortality in the ntreatment group (HR 2.73, 95% CI 1.20-6.24) (Figure B), but showed significant difference in no-tratment group (HR 1.39, 95% CI 0.86-2.24) (Figure C).

Conclusion

Even one deviation of PTH concentrations from the optimal range during a one-year period was associated with an increase in all-cause mortality. However, this effect was not seen when patients were receiving pharmacological intervention. The results suggest that early intervention is desirable when PTH levels vary from the optimal range in patients with secondary hyperparathyroidism.