Abstract: TH-PO133
Parathyroid Hormone and Cardiovascular Risk in Patients with CKD
Session Information
- CKD-MBD: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Pichat, Caroline Sophie Hjelm, Herlev Hospital, Herlev, Hovedstaden, Denmark
- Ballegaard, Ellen Linnea Freese, Rigshospitalet, Kobenhavn, Denmark
- Bressendorff, Iain Oshoj, Herlev Hospital, Herlev, Hovedstaden, Denmark
- Joergensen, Hanne Skou, Aarhus Universitetshospital Risskov, Risskov, Midtjylland, Denmark
- Carlson, Nicholas, Rigshospitalet, Kobenhavn, Denmark
- Hansen, Ditte, Herlev Hospital, Herlev, Hovedstaden, Denmark
Background
Cardiovascular disease is highly prevalent in patients with chronic kidney disease (CKD). The aim of this study was to describe the association between parathyroid hormone (PTH) level and risk of cardiovascular disease in CKDG3-5.
Methods
The cohort was based on nationwide Danish health care registries. All Danish residents ≥18 years with eGFR <60 ml/min/1.73 m2 and measured PTH were identified between 2010 and 2022. Individuals with prior kidney transplantation, multiple myeloma, suppressed PTH, hypercalcemia ≥1.4mmoL, and current dialysis therapy were excluded. PTH was standardized based on the assay-specified upper normal limit (normal, 1.1-2.0xUNL, 2.1-4.0xUNL, and ≥4.0xUNL) with comparison of cumulative incidences of major cardiovascular outcomes (cardiomyopathy, heart failure, myocardial infarction, stroke, thromboembolism, and/or peripheral artery disease) based on the Aalen-Johansen estimator and multiple cause-specific Cox regression models adjusted for age, sex, and CKD stage with death as competing risk. Results were further tested in sensitivity analyses adjusted for phosphate.
Results
A total of 80,937 individuals were included. Median age was 74 yrs (IQR 65;82), 58% were female, 87% with CKDG3, and 62% with normal PTH. Male, sex and lower eGFR were associated with higher PTH levels. A total of 17,701 events were identified during a mean follow-up of 4.4 yrs. Cumulative incidence was highest with PTH >4xUNL (Figure 1). Higher PTH associated with increased rates of cardiovascular events (Figure 2). Principal results remained unchanged following adjustment for phosphate.
Conclusion
Increasing PTH may contribute to cardiovascular disease in patients with CKDG3-5. Further studies are needed to determine the PTH targets in pre-dialysis CKD.