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Titolo	Association of Relatively Low Serum Parathyroid Hormone With Malnutrition-Inflammation Complex and Survival in Maintenance Hemodialysis Patients
Autore	Ramanath Dukkipati, MD,* Csaba P. Kovesdy, MD, Sara Colman, RD,± Matthew J. Budoff, MD,§ Allen R. Nissenson, MD,± Stuart M. Sprague, DO, Joel D. Kopple, MD,* and Kamyar Kalantar-Zadeh, MD, MPH, PhD*
Referenza	Journal of Renal Nutrition 2010; doi:10.1053/j.jrn.2009.10.006
Contenuto	Background: Low serum parathyroid hormone (PTH) has been implicated as a primary biochemical marker of adynamic bone disease in individuals with chronic kidney disease (CKD) who undergo maintenance hemodialysis (MHD) treatment. We hypothesized that the malnutrition-inflammation complex is associated with low PTH levels in these patients and confounds the PTH-survival association. Methods: We examined 748 stable MHD outpatients in southern California and followed them for up to 5 years (October 2001-December 2006). Results: In 748 MHD patients, serum PTH ,150 pg/mL was more prevalent among non-blacks and diabetics. There was no association between serum PTH and coronary artery calcification score, bone mineral density, or dietary protein or calorie intake. Low serum PTH was associated with markers of protein-energy wasting and inflammation, and this association confounded the relationship between serum PTH and alkaline phosphatase. Although 5-year crude mortality rates were similar across PTH increments, after adjustment for the case-mix and surrogates of malnutrition and inflammation, a moderately low serum PTH in 100-150 pg/mL range was associated with the greatest survival compared to other serum PTH levels, i.e., a death hazard ratio of 0.52 (95% confidence interval: 0.29-0.92, p,0.001) compared to PTH of 300-600 pg/mL (reference).
Data	11.03.2010

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