CHICAGO—High levels of intact parathyroid hormone (iPTH) in chronic kidney disease (CKD) patients not on dialysis are associated with increased risks of early death, according to researchers presenting at Kidney Week 2016.
Investigators led by Alex R. Chang, MD, MS, of Geisinger Health System in Danville, Pennsylvania, examined multiple abnormalities of CKD Mineral and Bone Disorder (CKD-MBD) and their relationship with all-cause mortality in 4737 patients from the health system (average age 70.2) with estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m2. Given the increased fracture rate among CKD patients, they also studied the risk of fragility fractures in the wrist, humerus, hip, or spine. None had experienced a previous fracture nor had anyone developed end stage renal disease. The vast majority (90.4%) had hypertension, 33.3% type 2 diabetes, and 24.7% atherosclerotic cardiovascular disease.
Over a median follow-up of 6.2 years, 15% had a fracture and 30.8% died. Dr Chang and colleagues found that CKD-MBD markers at specific levels were associated with premature death, including low calcium (below 9.0 mg/dL), high phosphorus (4.0 mg/dL and above), low 25-OH vitamin D (below 20 ng/mL), and high iPTH (100 pg/mL and above). Death risk rose as more CKD-MBD markers reached their respective high-risk zones. Patients with 3 or 4 markers in the danger zone, for example, had more than double the chances of death than those with none resulting in 9.68 deaths per 100 persons per year. The findings held after competing causes of death were considered. A calcium level below 9.0 mg/dL was associated with a 28% increased risk of fracture.
Investigators accounted for demographic factors, renal risk factors, and bone-altering medications, such as cinacalcet, bisphosphonates, corticosteroids, diuretics, and testosterone.
“Future research is needed to determine optimal strategies to reduce morbidity and mortality associated with abnormal CKD-MBD parameters,” Dr Chang told Renal & Urology News.
- Chang AR, Young A, Bucaloiu, Hartle JE. Intact Parathyroid Hormone Is Associated with Increased Risk of Death but Not Fragility Fracture in Patients with Chronic Kidney Disease. Presented at: Kidney Week 2016. November 15-20, 2016. Chicago. Abstract 521.