Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients.

Abstract

BACKGROUND:

Low serum parathyroid hormone (PTH) has been implicated as a primary biochemical marker of adynamic bone disease in individuals with chronic kidney disease (CKD) who undergo maintenance hemodialysis (MHD) treatment. We hypothesized that the malnutrition-inflammation complex is associated with low PTH levels in these patients and confounds the PTH-survival association.

METHODS:

We examined 748 stable MHD outpatients in southern California and followed them for up to 5 years (October 2001-December 2006).

RESULTS:

In 748 MHD patients, serum PTH <150pg/mL was more prevalent among non-blacks and diabetics. There was no association between serum PTH and coronary artery calcification score, bone mineral density, or dietary protein or calorie intake. Low serum PTH was associated with markers of protein-energy wasting and inflammation, and this association confounded the relationship between serum PTH and alkaline phosphatase. Although 5-year crude mortality rates were similar across PTH increments, after adjustment for the case-mix and surrogates of malnutrition and inflammation, a moderately low serum PTH in 100-150pg/mL range was associated with the greatest survival compared to other serum PTH levels, i.e., a death hazard ratio of 0.52 (95% confidence interval: 0.29-0.92, p<0.001) compared to PTH of 300-600pg/mL (reference).

CONCLUSIONS:

Low serum PTH may be another facet of the malnutrition-inflammation complex in CKD, and after controlling for this confounder, a moderately low PTH in 100-150pg/mL range appears associated with the greatest survival. Limitations of observational studies should be considered.

• Authors: Ramanath Dukkipati, Csaba P Kovesdy, Sara Colman, Matthew J Budoff, Allen R Nissenson, Stuart M Sprague, Joel D Kopple, Kamyar Kalantar-Zadeh
• Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation (J Ren Nutr) Vol. 20 Issue 4 Pg. 243-54 (Jul 2010) ISSN: 1532-8503 [Electronic] United States
• PMID: 20199875 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Parathyroid Hormone
• Alkaline Phosphatase

Topics

• Alkaline Phosphatase (blood)
• Biomarkers (blood)
• Bone Density (physiology)
• Female
• Follow-Up Studies
• Humans
• Inflammation (blood, mortality)
• Kidney Failure, Chronic (blood, complications, mortality)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Protein-Energy Malnutrition (blood, mortality)
• Renal Dialysis
• Survival Analysis