Roles of Serum Calcium, Phosphorus, PTH and ALP on Mortality in Peritoneal Dialysis Patients: A Nationwide, Population-based Longitudinal Study Using TWRDS 2005-2012

Sci Rep. 2017 Feb 24;7(1):33. doi: 10.1038/s41598-017-00080-4.

Abstract

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 (PTH), higher serum levels were not associated increased mortality. For alkaline phosphatase (ALP), mortality increased at levels ≧100 IU/L. Our findings suggested that the detrimental effect of ALP on survival was more consistent, while serum calcium, phosphorus and PTH may have a less prominent effect on mortality. This study provided additional information for manipulating CKD-MBD biomarkers in PD patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Alkaline Phosphatase / blood
  • Biomarkers / blood*
  • Calcium / blood
  • Chronic Kidney Disease-Mineral and Bone Disorder / metabolism
  • Chronic Kidney Disease-Mineral and Bone Disorder / mortality*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Peritoneal Dialysis / mortality*
  • Phosphorus / blood
  • Survival Analysis
  • Taiwan / epidemiology

Substances

  • Biomarkers
  • Parathyroid Hormone
  • Phosphorus
  • Alkaline Phosphatase
  • Calcium