Association between CKD-MBD and mortality in older patients with advanced CKD-results from the EQUAL study.
In older patients with very advanced kidney disease not yet on dialysis, higher parathyroid hormone and phosphate were independently linked to a greater risk of death, with the highest risk when high calcium and high phosphate occurred together.
Background
CKD-mineral and bone disorder (CKD-MBD) is associated with higher mortality in dialysis patients, but its prognostic impact in non-dialysis patients, particularly older adults, has been largely unknown.
Study design
The European Quality (EQUAL) study enrolled patients aged 65 years or older with eGFR 20 mL/min/1.73m2 or lower from six European countries. Sequentially adjusted Cox models (baseline and time-dependent) related PTH, phosphate and calcium, and their interactions, to all-cause, cardiovascular and non-cardiovascular mortality in 1,294 patients.
Key findings
CKD-MBD prevalence at baseline was 94%. PTH (adjusted HR 1.12, 95% CI 1.03-1.23) and phosphate (aHR 1.35, 1.00-1.84) were associated with all-cause mortality; calcium was not independently associated but modified the effect of phosphate, with the highest risk in patients with both hypercalcaemia and hyperphosphataemia. PTH was associated with cardiovascular mortality, while phosphate was associated with both cardiovascular and non-cardiovascular mortality.
Clinical implications
CKD-MBD biomarkers carry prognostic weight before dialysis in older patients. The independent association of PTH and phosphate with mortality, and the amplified risk when calcium and phosphate are both elevated, supports attention to phosphate and combined mineral control in advanced non-dialysis CKD.
Category
Research
Source
Nephrology Dialysis Transplantation
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