Comparison of calcium and phosphorus homeostasis between hemodialysis and peritoneal dialysis in patients with end-stage renal disease (original) (raw)
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Objective: Many people who have severe chronic kidney disease (CKD) will eventually develop kidney failure and will require dialysis. The control of parathormone (PTH), phosphorus, and calcium metabolism is one of the objectives in an adequate dialysis protocol. Therefore, we conducted this study to describe alterations in PTH, calcium, and phosphorous homeostasis in patients with CKD on hemodialysis in our center. Our study also aimed to find an association between hormonal and biochemical abnormalities in CKD patients, who have been on hemodialysis for ≥5 months and comparing the results obtained with that recommended by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Methods: This was a hospital-based cross-sectional observational study. The study population of 330 patients (>18 years) on maintenance hemodialysis coming to dialysis
2021
Background: Chronic kidney disease (CKD) is considered the popular disorder throughout the world. It associates with abnormalities of mineral metabolism such as calcium, phosphorus and parathyroid hormone. Objectives: The study aimed to evaluate the alteration of serum levels of Ca, Ph, and PTH in hemodialysis patients in in Zawia Kidney Center, Western Libya, and determining the relationship of age with the levels of these parameters. Subjects and Methods: One hundred subjects were included in the present study. Out of which 50 cases were dialysis patients collecting from AZ-Zawia kidney center and 50 subjects were health individuals used as control divided into male and female, mean age was 47.03±14.14 years. Five ml of venous blood was collected from each participant for estimating the serum levels of PTH, Ca, and Ph. Results: The result showed that the level of PTH was higher than normal, where the mean level of PTH in dialysis patients was 421.64±391.30 and 44.59 ± 12.32 pg/ml ...
Scientific reports, 2017
Biomarkers of chronic kidney disease-mineral and bone disorder (CKD-MBD) correlate with morbidity and mortality in dialysis patients. However, the comparative roles of each CKD-MBD biomarker remained undetermined on long-term peritoneal dialysis (PD) patients. This retrospective study, employing a population-based database, aimed to evaluate the performance and provide the best evidence of each biomarker of CKD-MBD as predictor of all-cause mortality. Throughout the 8-year study period, total 12,116 PD patients were included in this study. Cox proportional regression and Kaplan-Meier method were used for survival analysis. For Cox regression model, baseline measurements and time-varying covariates were used for analysis. In Cox regression model using time-dependent covariates, serum calcium level of ≧9.5 mg/dL was associated with increased mortality. For phosphorus, serum levels of either ≧6.5 mg/dL or <3.5 mg/dL were associated with increased mortality. For parathyroid hormone (...
Therapeutic Apheresis and Dialysis, 2008
Disturbances in bone mineral metabolism are common in chronic hemodialysis (HD) patients and often underlie morbid conditions and mortality; however, no large epidemiological study for Asian dialysis patients has been performed. We analyzed the database of the Japanese Society for Dialysis Therapy registry. In this study, data from patients who were on HD at the end of 2000 was compiled. The Cox's proportional hazard analysis was carried out to evaluate the significance of the impact of variables related to bone mineral metabolism on survival after adjusting for possible confounding variables. The study period was three years, and a cohort of 27 404 HD patients was studied. The hazard ratios were 1.098 (P = 0.0129) for serum calcium levels ranging 10.0-10.9 mg/ dL, and 1.243 (P = 0.0001) for serum calcium levels >11.0 mg/dL when the reference serum calcium level range was 9.0-9.9 mg/dL. Similarly, the hazard ratios were significantly higher in a serum phosphorous level of 5.0 mg/dL than for the reference serum phosphorous level range of 4.0-4.9 mg/dL. For intact parathyroid hormone (iPTH), the hazard ratios were significantly small (<119 pg/mL) when the reference iPTH level range was 180-359 pg/mL. However, the hazard ratio did not increase when the iPTH level increased to >360 pg/mL. Results showed that disturbances in bone mineral metabolism, such as those involving serum calcium, phosphorous, and iPTH, have a significant impact on survival in Japanese dialysis patients.
Phosphorus control in peritoneal dialysis patients
Kidney International, 2008
Hyperphosphatemia is independently associated with an increased risk of death among dialysis patients. In this study, we have assessed the status of phosphate control and its clinical and laboratory associations in a large international group of patients on chronic peritoneal dialysis (PD) treatment. This cross-sectional multicenter study was carried out in 24 centers in three different countries (Canada, Greece, and Turkey) among 530 PD patients (235 women, 295 men) with a mean+/-s.d. age of 55+/-16 years and mean duration of PD of 33+/-25 months. Serum calcium (Ca(2+)), ionized Ca(2+), phosphate, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D(3), 1,25-dihydroxy vitamin D(3), total alkaline phosphatase, and bone alkaline phosphatase concentrations were investigated, along with adequacy parameters such as Kt/V, weekly creatinine clearance, and daily urine output. Mean Kt/V was 2.3+/-0.65, weekly creatinine clearance 78.5+/-76.6 l, and daily urine output 550+/-603 ml day(-1)...
Serum Calcium, Phosphorous, and Parathyroid Hormone in Sudanese Patients under Regular Haemodialysis
2013
Background Secondary hyperparathyroidism (SHPT) is an important complication of end-stage renal disease. Bone disease, a well-recognized complication of SHPT, represents only a small concern in light of the evidence that correlates SHPT with cardiovascular disease and an increased risk of morbidity and mortality in patients with CKD. Identifying patients at risk and evaluating for SHPT is imperative because early intervention may slow or arrest the progression of both bone and cardiac disease. Dietary concerns, pharmacotherapy, and patient adherence are all important considerations in creating a successful treatment plan. Aims To evaluate serum calcium, phosphorus and parathyroid hormone concentrations in hemodialyzed renal failure patients. Materials and Methods The study involved a control group of apparently healthy (N = 50) matched for age with a test group of hemodialyzed renal failure patients (N = 50). The age range of both groups was 25-65 years. Calcium, phosphorus and para...
Journal of nephrology
Despite substantial progress in medical care, the mortality rate remains unacceptably high in dialysis patients. Evidence suggests that bone mineral dismetabolism (CKD-MBD) might contribute to this burden of death. However, to date only a few papers have investigated the clinical relevance of serum mineral derangements and the impact of different therapeutic strategies on mortality in a homogeneous cohort of south European dialysis patients. The RISCAVID study was a prospective, observational study in which all patients receiving hemodialysis (HD) in the north-western region of Toscany in June 2004 were enrolled (N=757) and followed up for 24 months. At study entry, only 71 (9%) patients of the entire study cohort exhibited an optimal control of serum phosphorous (Pi), calcium (Ca), calciumX-phosphorous product (CAXPi) and intact parathyroidhormone (iPTH) according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical guidelines. Despite a similar prevalence, the sever...
International Journal of Research in Medical Sciences, 2019
Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P va...
Journal of the American Society of Nephrology, 2015
Uncorrected serum calcium concentration is the first mineral metabolism metric planned for use as a quality measure in the United States ESRD population. Few studies in patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) have assessed the association of uncorrected serum calcium concentration with clinical outcomes. We obtained data from 129,076 patients on dialysis (PD, 10,066; HD, 119,010) treated in DaVita, Inc. facilities between July 1, 2001, and June 30, 2006. After adjustment for potential confounders, uncorrected serum calcium ,8.5 and 10.2mg/dlwereassociatedwithexcessmortalityinpatientsonPDorHD(comparisongroupuncorrectedcalcium9.0to,9.5mg/dl).Additionaladjustmentforserumalbuminconcentrationsubstantiallyattenuatedtheall−causemortalityhazardratios(HRs)associatedwithuncorrectedcalcium,8.5mg/dl(HR,1.29;9510.2 mg/dl were associated with excess mortality in patients on PD or HD (comparison group uncorrected calcium 9.0 to ,9.5 mg/dl). Additional adjustment for serum albumin concentration substantially attenuated the all-cause mortality hazard ratios (HRs) associated with uncorrected calcium ,8.5 mg/dl (HR, 1.29; 95% confidence interval [95% CI], 1.16 to 1.44 for PD; HR, 1.17; 95% CI, 1.13 to 1.20 for HD) and amplified the HRs associated with calcium 10.2mg/dlwereassociatedwithexcessmortalityinpatientsonPDorHD(comparisongroupuncorrectedcalcium9.0to,9.5mg/dl).Additionaladjustmentforserumalbuminconcentrationsubstantiallyattenuatedtheall−causemortalityhazardratios(HRs)associatedwithuncorrectedcalcium,8.5mg/dl(HR,1.29;9510.2 mg/dl (HR, 1.65; 95% CI, 1.42 to 1.91 for PD; HR, 1.59; 95% CI, 1.53 to 1.65 for HD). Albumin-corrected calcium 10.2mg/dlandserumphosphorus10.2 mg/dl and serum phosphorus 10.2mg/dlandserumphosphorus6.4 mg/dl were also associated with increased risk for death, irrespective of dialysis modality. In summary, in a large nationally representative cohort of patients on dialysis, abnormalities in markers of mineral metabolism, particularly high concentrations of serum calcium and phosphorus, were associated with increased mortality risk. Additional studies are needed to investigate whether control of hypercalcemia and hyperphosphatemia in patients undergoing dialysis results in improved clinical outcomes.