Hemodialysis (HD) patients with chronic kidney disease-mineral bone disorder (CKD-MBD) have an increased risk of death. To decrease this risk, researchers in Taiwan concluded on the basis of a study that the priority should be to focus on achieving target calcium levels or simultaneously achieving target phosphorus and intact parathyroid hormone levels.

Jin-Bor Chen, MD, of Kaohsiung Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues reviewed the medical records of 1126 HD outpatients treated at their institution from 2009–2013. They examined the relationship between attainment of Kidney Disease: Improving Global Outcomes (KDIGO) guideline target levels of calcium (Ca), phosphate (P), and intact parathyroid hormone (iPTH) and the risks for all-cause and cardiovascular (CV) mortality. According to KDIGO guidelines, the reference target ranges for CKD-MBD biochemical markers are 7.9 to 9.9 mg/dL for Ca; 2.4 to 4.7 mg/dL for P; and 144 to 648 pg/mL for iPTH. 

During 5 years of follow up, 240 patients died from any cause and 48 from CV problems. Failing to reach any of the 3 targets was associated with increased all-cause mortality compared with meeting 2 targets, Dr Chen’s group reported in BioMedical Research International.

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In case-mix adjusted and multivariable adjusted logistic regression analyses, patients who achieved target serum Ca levels had a lower risk for all-cause mortality compared with those who achieved target serum P or iPTH levels. Compared with patients who achieved all CKD-MBD biomarker targets, patients who achieved target serum Ca, P, and iPTH levels had 3.16, 3.55, and 4.70 times higher odds of all-cause mortality, respectively.

Among patients with 2 biomarkers within range, achieving target P + iPTH levels was associated with lower odds of all-cause mortality compared with achieving target Ca + iPTH and Ca + P levels. Compared with patients who achieved all target levels, patients who achieved target P + iPTH, Ca + iPTH, and Ca + P levels had 32%, 43%, and 66% higher odds of all-cause mortality, respectively. The risks for cardiovascular mortality followed the same pattern.

“Based on this finding, we suggest that achieving target serum Ca level or simultaneously achieving P + iPTH levels should be prioritized in the management of CKD-MBD in prevalent HD patients, ” Dr Chen and colleagues wrote.

The findings generally agree with previous studies, although the investigators cited several discrepancies that they partly attribute to their small sample size and methodological differences.

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1. Liu Y, Lee WC, Cheng BC, Li LC, Lee CH, Chang WX, and Chen JB. Association between the Achievement of Target Range CKD-MBD Markers and Mortality in Prevalent Hemodialysis Patients in Taiwan by Using the Kidney Disease: Improving Global Outcomes Clinical Guidelines. Biomed Res Int. vol 2016. doi: 10.1155/2016/1523124