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Titolo	Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population
Autore	Jürgen Floege1, Joseph Kim2, Elizabeth Ireland2, Charles Chazot3, Tilman Drueke4, Angel de Francisco5, Florian Kronenberg6, Daniele Marcelli7, Jutta Passlick-Deetjen7, Guntram Schernthaner8, Bruno Fouqueray9, David C. Wheeler10 and on behalf of the ARO Investigators -1RWTH University of Aachen, Aachen, Germany, 2Amgen Ltd, Uxbridge, UK, 3Nephrocare Tassin, France, 4Hopital Necker, Paris, France, 5Hospital Universitario Valdecilla, Santander, Spain, 6Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria, 7Fresenius Medical Care, Bad Homburg, Germany, 8Rudolfstiftung Hospital-Vienna, Vienna, Austria, 9Amgen (Europe) GmbH, Zug, Switzerland and 10University College London, UK
Referenza	Nephrol Dial Transplant (2010); doi: 10.1093/ndt/gfq219
Contenuto	Background. A number of US observational studies reported an increased mortality risk with higher intact parathyroid hormone (iPTH), calcium and/or phosphate. The existence of such a link in a European haemodialysis population was explored as part of the Analysing Data, Recognising Excellence and Optimising Outcomes (ARO) Chronic Kidney Disease (CKD) Research Initiative. Methods. The association between the markers of mineral and bone disease and clinical outcomes was examined in 7970 patients treated in European Fresenius Medical Care facilities over a median of 21 months. Baseline and timedependent (TD) Cox regression were performed using Kidney Disease Outcomes Quality Initiative (KDOQI) target ranges as reference categories, adjusting for demographics, medical history, dialysis parameters, inflammation, medications and laboratory parameters. Fractional polynomial (FP) models were also used. Results. Hazard ratio (HR) estimates from baseline analysis for iPTH were U-shaped [>600 pg/mL, HR = 2.10, 95% confidence interval (CI) 1.62-2.73; <75 pg/mL, HR = 1.46, 95% CI 1.17-1.83]. TD analysis confirmed the results for iPTH. Baseline analysis showed that calcium >2.75 mmol/L increased risk of death (HR = 1.70, 95% CI 1.19-2.42). TD analysis showed that both low (HR = 1.19, 95% CI 1.04-1.37) and high calcium (HR = 1.74, 95% CI 1.30-2.34) increased risk of death. Baseline analysis for phosphate showed a U-shaped pattern (<1.13 mmol/L, HR = 1.18, 95% CI 1.01-1.37; >1.78 mmol/L, HR = 1.32, 95% CI 1.13-1.55). TD analysis confirmed the results for phosphate <1.13 mmol/L. HR estimates were higher in patients with diabetes versus those without diabetes for baseline analysis only (P-value = 0.014). FP analysis confirmed the results of baseline and TD analyses. Conclusion. Patients with iPTH, calcium and phosphate levels within the KDOQI target ranges have the lowest risk of mortality compared with those outside the target ranges.
Data	28.05.2010

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