Levels of serum markers of chronic kidney disease mineral bone disorders (CKD-MBD) vary across dialysis modalities, a new study finds.
In a retrospective study of 132,523 patients initiating dialysis from 2007 to 2011, 86% were treated with conventional thrice-weekly in-center hemodialysis (HD), 0.8% longer nocturnal in-center hemodialysis (NICHD), 11.6% frequent peritoneal dialysis (PD), and 1.3% frequent home hemodialysis (HHD). Over a median follow-up of 17 months, 32,631 (25%) deaths and 5,733 (4%) kidney transplants occurred.
Parathyroid Hormone: At baseline, the PD group had the lowest mean and median values of parathyroid hormone (PTH) and the NICHD group had the highest median values.
Compared with conventional in-center HD (370.1 pg/mL), patients treated with NICHD had a significant 19.8 pg/mL lower mean serum PTH during follow-up. Those treated with PD and HHD had a significant 39.7 and 51.2 pg/mL higher mean PTH, respectively.
Phosphate: Compared with conventional in-center HD (5.63 mg/dL), phosphate levels were a significant 0.44, 0.15, and 0.33 mg/dL lower for patients treated with NICHD, PD, or HHD, respectively.
Calcium and Alkaline Phosphatase (ALP): There were no clinically meaningful associations between dialysis modalities and concentrations of calcium or ALP. A slightly higher serum calcium level among the NICHD group was attributed to the more frequent use of high dialysate calcium bath.
These real-world practice patterns reflect dialysis prescription (such as treatment time and frequency) and medication adjustments to meet treatment goals, Elani Streja, PhD, MPH, of the University of California Irvine Medical Center, Orange, California, and colleagues explained in the American Journal of Nephrology. The investigators noted that many patients had residual kidney function and could achieve current targets for dialysis adequacy with less intensified dialysis. CKD-MBD biomarker patterns may differ for patients with longer dialysis vintage.
“Given the expected growth in dialysis modalities other than conventional in-center hemodialysis, especially home modalities, it is imperative to understand the relationship between dialysis modalities and patterns of CKD-MBD markers,” Dr Streja’s team wrote. “Future studies should investigate these relationships with a special focus on hard clinical outcomes and patient-centered outcomes.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Soohoo M, Obi Y, Rivara MB, et al. Comparative effectiveness of dialysis modality on laboratory parameters of mineral metabolism. Am J Nephrol. Published online February 28, 2022. doi:10.1159/000521508