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International variations in serum PTH and calcium levels and their mortality associations in peritoneal dialysis patients: Results from PDOPPS

Nitta, Kosaku; Bieber, Brian; Karaboyas, Angelo; Johnson, David W; Kanjanabuch, Talerngsak; Kim, Yong-Lim; Lambie, Mark; Hartman, John; Shen, Jenny I; Naljayan, Mihran; Pecoits-Filho, Roberto; Robinson, Bruce M; Pisoni, Ronald L; Perl, Jeffrey; Kawanishi, Hideki

Authors

Kosaku Nitta

Brian Bieber

Angelo Karaboyas

David W Johnson

Talerngsak Kanjanabuch

Yong-Lim Kim

John Hartman

Jenny I Shen

Mihran Naljayan

Roberto Pecoits-Filho

Bruce M Robinson

Ronald L Pisoni

Jeffrey Perl

Hideki Kawanishi



Abstract

Background:
Mineral bone disorder (MBD) in chronic kidney disease (CKD) is associated with high symptom burden, fractures, vascular calcification, cardiovascular disease and increased morbidity and mortality. CKD-MBD studies have been limited in peritoneal dialysis (PD) patients. Here, we describe calcium and parathyroid hormone (PTH) control, related treatments and mortality associations in PD patients.

Methods:
We used data from eight countries (Australia and New Zealand (A/NZ), Canada, Japan, Thailand, South Korea, United Kingdom, United States (US)) participating in the prospective cohort Peritoneal Dialysis Outcomes and Practice Patterns Study (2014–2022) among patients receiving PD for >3 months. We analysed the association of baseline PTH and albumin-adjusted calcium (calciumAlb) with all-cause mortality using Cox regression, adjusted for potential confounders, including serum phosphorus and alkaline phosphatase.

Results:
Mean age ranged from 54.6 years in South Korea to 63.5 years in Japan. PTH and serum calciumAlb were measured at baseline in 12,642 and 14,244 patients, respectively. Median PTH ranged from 161 (Japan) to 363 pg/mL (US); mean calciumAlb ranged from 9.1 (South Korea, US) to 9.8 mg/dL (A/NZ). The PTH/mortality relationship was U-shaped, with the lowest risk at PTH 300–599 pg/mL. Mortality was nearly 20% higher at serum calciumAlb 9.6+ mg/dL versus 8.4–<9.6 mg/dL. MBD therapy prescriptions varied substantially across countries.

Conclusions:
A large proportion of PD patients in this multi-national study have calcium and/or PTH levels in ranges associated with substantially higher mortality. These observations point to the need to substantially improve MBD management in PD to optimise patient outcomes.

Lay Summary:
Chronic kidney disease-mineral bone disorder (MBD) is a systemic condition, common in dialysis patients, that results in abnormalities in parathyroid hormone (PTH), calcium, phosphorus and vitamin D metabolism. A large proportion of peritoneal dialysis (PD) patients in this current multi-national study had calcium and/or PTH levels in ranges associated with substantially higher risks of death. Our observational study design limits our ability to determine whether these abnormal calcium and PTH levels cause more death due to possible confounding that was not accounted for in our analysis. However, our findings, along with other recent work showing 48–75% higher risk of death for the one-third of PD patients having high phosphorus levels (>5.5 mg/dL), should raise strong concerns for a greater focus on improving MBD management in PD patients.

Citation

Nitta, K., Bieber, B., Karaboyas, A., Johnson, D. W., Kanjanabuch, T., Kim, Y.-L., Lambie, M., Hartman, J., Shen, J. I., Naljayan, M., Pecoits-Filho, R., Robinson, B. M., Pisoni, R. L., Perl, J., & Kawanishi, H. (2024). International variations in serum PTH and calcium levels and their mortality associations in peritoneal dialysis patients: Results from PDOPPS. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 14(3), https://doi.org/10.1177/08968608241235516

Journal Article Type Article
Acceptance Date Mar 1, 2024
Online Publication Date Mar 19, 2024
Publication Date Mar 19, 2024
Deposit Date Apr 9, 2024
Publicly Available Date May 28, 2024
Journal Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Print ISSN 0896-8608
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 14
Issue 3
DOI https://doi.org/10.1177/08968608241235516
Keywords Calcium; epidemiology; mortality; parathyroid hormone; peritoneal dialysis
Public URL https://keele-repository.worktribe.com/output/786952

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Licence
https://creativecommons.org/licenses/by-nd/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by-nd/4.0/

Copyright Statement
Kosaku Nitta et al, International variations in serum PTH and calcium levels and their mortality associations in peritoneal dialysis patients: Results from PDOPPS, Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, OnlineFirst, Copyright © 2024, (Sage). DOI: 10.1177/08968608241235516

The final version of this article and all relevant information related to it, including copyrights, can be found on the publisher website.





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