Elevated PTH May Increase Short-Term Mortality Risk in CKD Patients

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DENVER—Higher parathyroid hormone (PTH) levels are associated with an increased risk of death, possibly because of a higher prevalence of metabolic syndrome as well as other possible pathways.

In a cross-sectional analysis of 5,780 participants in the National Kidney Foundation's Kidney Early Evaluation Program, Georges Saab, MD, of Washington University in St. Louis, and colleagues, examined the association between serum calcium, phosphorus, and PTH levels with short-term mortality among individuals with CKD but not on dialysis. 

Over a median follow-up of two years, 152 deaths occurred. After adjusting for age, race, gender, smoking, alcohol use, estimated glomerular rate, education level, recent doctor visits, insurance coverage, and prior cardiovascular disease, each standard deviation in natural log transformed PTH was associated with a significant 20% higher risk of death. Each 1 mg/dL increase in serum calcium and phosphorus was not associated with increased mortality.

Because PTH levels are associated with an increased prevalence of metabolic syndrome, the researchers also adjusted for individual components of the syndrome (obesity, hypertension, dyslipidemia, dysglycemia, and microalbuminuria). The association of PTH with mortality was only mildly attenuated, but it was no longer statistically significant. 

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