Abstract
BackgroundSerum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients. Peritonitis is the most common and fatal infectious complication, resulting in technique failure, hospital admission and mortality. Whether PTH is associated with peritonitis episodes remains unclear.MethodsWe examined the association of PTH levels and peritonitis incidence in a 7-year cohort of 270 incident PD patients who were maintained on dialysis between January 2012 and December 2018 using Cox proportional hazard regression analyses. Patients were categorized into three groups by serum PTH levels as follows: low-PTH group, PTH < 150 pg/mL; middle-PTH group, PTH 150-300 pg/mL; high-PTH group, PTH > 300 pg/mL.ResultsDuring a median follow-up of 29.5 (interquartile range 16–49) months, the incidence rate of peritonitis was 0.10 episodes per patient-year. Gram-positive organisms were the most common causative microorganisms (36.2%), and higher percentage of Gram-negative organisms was noted in patients with low PTH levels. Low PTH levels were associated with older age, higher eGFR, higher hemoglobin, calcium levels and lower phosphate, alkaline phosphatase levels. After multivariate adjustment, lower PTH levels were identified as an independent risk factor for peritonitis episodes [hazard ratio 1.643, 95% confidence interval 1.014–2.663, P = 0.044].ConclusionsLow PTH levels are independently associated with peritonitis in incident PD patients.
Highlights
Serum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients
315 end-stage renal disease (ESRD) patients who started maintenance PD therapy for the first time between 1 January 2012 and 31 December 2018 were followed-up at our PD center, of whom 7 patients were younger than 18 years, 12 patients were on PD less than 3 months, and 26 patients had not available data of baseline PTH levels
It’s worth mentioning that eight patients whose primary cause of ESRD was vasculitis have not received immunosuppressive treatment, and have initiated PD therapy because of a low disease activity
Summary
Serum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients. Peritonitis is the most common and fatal infectious complication, resulting in technique failure, hospital admission and mortality. Abnormalities in serum parathyroid hormone (PTH) are exceedingly common in end-stage renal disease (ESRD) patients on maintenance dialysis and associated with cardiovascular disease, disturbances in bone mineral disorders, even increased morbidity and mortality in most. Dukkipati et al [8] have proven an association between low PTH levels (< 150 pg/mL) and malnutrition-inflammation-complex (MICS) in dialysis patients. In a large prospective cohort of 1771 incident dialysis patients, Hong et al [9] identified that low PTH levels (< 150 pg/mL) were an independent risk factor for infection-related mortality in dialysis patients both with hemodialysis and with PD and was even more meaningful in infection-related mortality than all-cause mortality. There are no data available about the association of PTH with peritonitis in PD patients
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