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Titolo ASN 2005 - [PUB546] Mineral Metabolism (MM) and Outcomes in Chronic Kidney Disease (CKD): The Renal Research Institute (RRI)-CKD Study.
Autore G. Eisele, M. Kiser, X. Zhang, S. Chung, B. Gillespie, F. Finkelstein, N. Levin, M. Kuhlmann, S. Rajagopalan, R. Saran Int Med, Med Coll Albany, Albany, NY; Int Med, UNC, Chapel Hill, NC; KECC, U Mich, Ann Arbor, MI; Int Med, Yale Univ, New Haven, CT; RRI, New York, NY; Int Med, Mt Sinai School of Med, New York, NY
Referenza ASN 2005 - 8.11.2005 - 13.11.2005 Philadelphia, Pennsylvania, USA
Contenuto MM practices and associations with CKD progression, ESRD, and mortality were examined. The RRI-CKD cohort includes patients (pts) in CKD stages III-V at 4 US centers. Lab tests ordered by clinic nephrologists [serum calcium (Ca), serum phosphate (P), parathyroid hormone (PTH)], comorbidities, P binders and Vit D prescriptions were recorded. Ca and P at enrollment were analyzed as predictors of mortality (Cox) and progression of CKD expressed as MDRD GFR slope (multiple regression), adjusting for demographics, BMI, BP, comorbidities, proteinuria, serum albumin and ACEI. In 631 pts mean age was 61 yrs, mean GFR 23.3 ml/min/1.73m2, 44% female, 21% AA, 37% diabetic, and median follow-up 694 days. Number of MM measurements (per pt/yr) for Ca, P, and PTH were 4.3, 2.9 and 0.53, respectively. Vit D was prescribed in 0.3% and P binders in 18.2%. P was >4.5 mg/dl in 38%, Ca x P was >50 in 8%, and PTH was >400 pg/ml in 22% at enrollment. P and Ca x P were both significantly associated with faster GFR decline, and composite outcome of death/dialysis. Ca was not significantly related to death/dialysis, but had a quadratic relationship with GFR slope, with slowest GFR decline at Ca=9 mg/dl, and faster decline for Ca values farther away from 9 in either direction. Mineral Metabolism and Outcomes in CKD Variable GFR slope p-value HR (composite) p-value Ca 18.4 0.009 1.08 NS Ca -0.96 0.015 P -0.84 0.018 1.64 <0.0001 Ca X P -0.12 <0.0001 1.07 <0.0001 ml/min/1.73m/yr, Quadratic term, HR=Hazard Ratio, All regressions adjusted for demographics, comorbidities, SBP, ACEI, albumin, proteinuria. This CKD cohort was characterized by infrequent MM monitoring and low Vit D or P binder use. Ca and P were associated with progression of CKD. Higher P and Ca x P predicted death/dialysis. MM deserves greater attention in pre-dialysis CKD. Disclosure - Grant/Research Support: Renal Research Institute
Data 20.12.2005
 
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