Improvement of Mineral and Bone Metabolism Markers Is Associated with Better Survival in Haemodialysis Patients: the COSMOS Study

• Main Author: Fernández-Martín, JL
• Publication Date: 2015
• Other Authors: Martínez-Camblor, P, Dionisi, MP, Floege, J, Ketteler, M, London, G, Locatelli, F, Gorriz, JL, Rutkowski, B, Ferreira, A, Bos, WJ, Covic, A, Rodríguez-García, M, Sánchez, JE, Rodríguez-Puyol, D, Cannata-Andia, JB
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://hdl.handle.net/10400.17/2515
• topic: Adult; Biomarkers/blood; Bone and Bones/metabolism; Calcium/blood; Europe/epidemiology; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary/blood; Male; Middle Aged; Parathyroid Hormone/blood; Phosphorus/blood; Prognosis; Proportional Hazards Models; Prospective Studies; Renal Dialysis/mortality; Renal Insufficiency, Chronic/therapy; Survival Rate; HCC NEF; Hyperparathyroidism, Secondary/mortality

BACKGROUND: Abnormalities in serum phosphorus, calcium and parathyroid hormone (PTH) have been associated with poor survival in haemodialysis patients. This COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis assesses the association of high and low serum phosphorus, calcium and PTH with a relative risk of mortality. Furthermore, the impact of changes in these parameters on the relative risk of mortality throughout the 3-year follow-up has been investigated. METHODS:COSMOS is a 3-year, multicentre, open-cohort, prospective study carried out in 6797 adult chronic haemodialysis patients randomly selected from 20 European countries. RESULTS:Using Cox proportional hazard regression models and penalized splines analysis, it was found that both high and low serum phosphorus, calcium and PTH were associated with a higher risk of mortality. The serum values associated with the minimum relative risk of mortality were 4.4 mg/dL for serum phosphorus, 8.8 mg/dL for serum calcium and 398 pg/mL for serum PTH. The lowest mortality risk ranges obtained using as base the previous values were 3.6-5.2 mg/dL for serum phosphorus, 7.9-9.5 mg/dL for serum calcium and 168-674 pg/mL for serum PTH. Decreases in serum phosphorus and calcium and increases in serum PTH in patients with baseline values of >5.2 mg/dL (phosphorus), >9.5 mg/dL (calcium) and <168 pg/mL (PTH), respectively, were associated with improved survival. CONCLUSIONS:COSMOS provides evidence of the association of serum phosphorus, calcium and PTH and mortality, and suggests survival benefits of controlling chronic kidney disease-mineral and bone disorder biochemical parameters in CKD5D patients.