Association between the Achievement of Target Range CKD-MBD Markers and Mortality in Prevalent Hemodialysis Patients in Taiwan by Using the Kidney Disease: Improving Global Outcomes Clinical Guidelines.

Ying Liu,Ben-Chung Cheng,Lung-Chih Li,Chih-Hsiung Lee,Wen-Xiu Chang,Jin-Bor Chen,Wen-Chin Lee

doi:10.1155/2016/1523124

Ying Liu, Ben-Chung Cheng + Show 5 more

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https://doi.org/10.1155/2016/1523124

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Abstract

Background. This study evaluated the association between achieving target chronic kidney disease-mineral and bone disorder (CKD-MBD) marker levels and mortality in Taiwanese hemodialysis (HD) patients. Target levels were based on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Methods. We performed a retrospective medical record review of 1126 HD patients between 2009 and 2013. A logistic regression model was used to evaluate the relationship between achieving target marker levels and the risk for all-cause and cardiovascular (CV) mortality. Reference target ranges were 7.9 ≤ calcium (Ca) ≤ 9.9 mg/dL, 2.4 ≤ phosphate (P) ≤ 4.7 mg/dL, and 144 ≤ intact parathyroid hormone (iPTH) ≤ 648 pg/mL. Results. Achievement of target P levels was associated with a lower risk for all-cause mortality compared to achievement of either target Ca or iPTH levels. Achieving target P + iPTH levels (OR 1.32) was associated with a lower odds ratio for all-cause mortality compared to achieving target Ca + P (OR 1.66) and Ca + iPTH (OR 1.43) levels. Similar trends were observed for CV mortality risk. Conclusions. The present study demonstrated that achieving serum P levels within the KDIGO target range is the most important factor for lowering mortality in HD patients.

Highlights

Chronic kidney disease-mineral and bone disorder (CKDMBD) has emerged as an important factor in the care of CKD patients
We examined the association between mortality and achievement of Kidney Disease: Improving Global Outcomes (KDIGO) recommended target ranges of chronic kidney disease-mineral and bone disorder (CKD-MBD) markers (Ca, P, and intact parathyroid hormone (iPTH)) in a cohort of HD patients
When examining the association between simultaneously achieving target levels for two CKD-MBD markers and the risk for mortality, we found that patients who achieved target P + iPTH levels had a lower risk for all-cause and CV mortality than those who achieved either Ca + P or Ca + iPTH targets by fully adjusted model analysis

Summary

Introduction

Chronic kidney disease-mineral and bone disorder (CKDMBD) has emerged as an important factor in the care of CKD patients. In the past several decades, many epidemiologic studies have revealed that CKD-MBD markers are associated with higher rates for both all-cause and cardiovascular (CV) mortality [2,3,4,5,6,7]. This study evaluated the association between achieving target chronic kidney disease-mineral and bone disorder (CKD-MBD) marker levels and mortality in Taiwanese hemodialysis (HD) patients. Achievement of target P levels was associated with a lower risk for all-cause mortality compared to achievement of either target Ca or iPTH levels. The present study demonstrated that achieving serum P levels within the KDIGO target range is the most important factor for lowering mortality in HD patients

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