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Journal Article Observational Study Ppublish 4 citations

PubMed: 39222240 DOI: 10.1007/s11255-024-04188-1

PTH may predict early mortality in incident patients on hemodialysis: results from a large cohort.

Int Urol Nephrol 57(2):545-551

Authors: Hugo B S Aquino, Maria Eugenia F Canziani, Ana Beatriz L Barra, Ana Paula Roque-da-Silva, Jorge Paulo Strogoff-de-Matos, Maria Aparecida Dalboni, Rosa M A Moyses, Rosilene M Elias

Affiliations

  • Universidade Nove de Julho (UNINOVE), Sao Paulo, (SP), Brazil.
  • Departamento de Medicina, Divisão de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil.
  • Fresenius Medical Care, Rio de Janeiro RJ, Brasil.
  • Departamento de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
  • Departamento de Medicina, Divisão de Nefrologia, Universidade de São Paulo, São Paulo, Brazil.
  • Universidade Nove de Julho (UNINOVE), Sao Paulo, (SP), Brazil.
  • Departamento de Medicina, Divisão de Nefrologia, Universidade de São Paulo, São Paulo, Brazil.

Abstract

PURPOSE

Parathyroid hormone (PTH) is merit as a risk factor for mortality in patients with chronic kidney disease in prevalent hemodialysis patients in a U shape. Most studies, however, do not focus on incident patients and those who died within the first 90 days of therapy. We evaluated PTH as a risk factor for mortality in a large cohort population in Brazil.

METHODS

This is an observational cohort study that included 4317 adult patients who initiated hemodialysis between July 1st, 2012 and June 30, 2017. The main outcome was all-cause mortality. Fine-gray sub-distribution hazard models were used to evaluate survival in the presence of a competing event (kidney transplant).

RESULTS

Median PTH levels of 252 (118, 479) pg/mL. There were 331 deaths during the first 90 days of therapy (6.7%), 430 in a 1-year follow-up (10.7%) and 1282 (32%) during the 5-year study period. Deaths according to PTH < 150, 150-600 and > 600 pg/mL corresponded to 38.1%, 33.0% and 28.5%, respectively (p < 0.001). In an adjusted model, patients who started dialysis with PTH < 150 pg/mL had a higher mortality risk within the first 90 days, but not in 1 year and 5 years after starting dialysis. Analyses in a subset of patients with a repeated PTH in 1 year (N = 1954) showed that although persistent PTH low levels (< 150 pg/mL) at 1 year were significantly associated with all-cause mortality, this result was not sustained after multiple adjustments.

CONCLUSION

PTH < 150 pg/mL confers a high mortality risk in the first 90 days of dialysis. If this result reflects poor nutritional conditions, it deserves further investigations.

MeSH

Kidney Diseases, Urology, Mortality, Kidney, Risk Factors, Therapeutics

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