Abstract
BackgroundMineral disorders are associated with adverse renal outcomes in chronic kidney disease (CKD) patients. Previous studies have associated hypercalcemia and hypocalcemia with mortality; however, the association between serum calcium and renal outcome is not well-described. Whether adding calcium besides phosphorus or in the form of calcium-phosphorus (Ca × P) product into the model of survival analysis could improve the prediction of renal outcomes is not known.MethodsA prospective cohort of 2144 outpatients with CKD stages 3–4 was evaluated. Cox proportional hazard analysis was performed according to calcium quartiles.ResultsThe mean calcium level was 9.2 ± 0.7 mg/dL. Low serum calcium (<9.0 mg/dL) was associated with increased risk of requiring renal replacement therapy (RRT) (hazards ratio [HR]:2.12 (95% CI: 1.49–3.02, P <0.05) and rapid renal function progression (odds ratio [OR]: 1.65 (95% CI: 1.19–2.27, P <0.05) compared with high serum calcium (>9.8 mg/dL). Adding calcium into the survival model increased the integrated discrimination improvement by 0.80% (0.12% – 1.91%) while calcium-phosphorus product did not improve risk prediction.The combination of high serum phosphorus (>4.2 mg/dL) and low serum calcium (<9.1 mg/dL) was associated with the highest risk of RRT (HR:2.31 (95% CI: 1.45–3.67, P < 0.05).ConclusionLow serum calcium is associated with increased risk of RRT and rapid renal function progression in CKD stage 3–4 patients. The integration of serum calcium and phosphorus, but not calcium-phosphorus product should be considered in a predictive model of renal outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-183) contains supplementary material, which is available to authorized users.
Highlights
Mineral disorders are associated with adverse renal outcomes in chronic kidney disease (CKD) patients
Bone mineral disorders have been implicated as a risk factor for mortality and renal replacement therapy (RRT) in chronic kidney disease (CKD) patients [1,2,3]
In this study, we showed that low serum calcium (
Summary
Mineral disorders are associated with adverse renal outcomes in chronic kidney disease (CKD) patients. Previous studies have associated hypercalcemia and hypocalcemia with mortality; the association between serum calcium and renal outcome is not well-described. Bone mineral disorders have been implicated as a risk factor for mortality and renal replacement therapy (RRT) in chronic kidney disease (CKD) patients [1,2,3]. Several observational studies have shown a significant association between high phosphorus levels with the progression of CKD [4,5] and RRT [4,6]. Young et al identified that hypercalcemia plays a critical modifying role in the pathogenesis of ischemic and toxic renal injury [11], and the association between hypercalcemia and acute kidney injury was observed in malignancy, hyperparathyroidism, and sarcoidosis [12]
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