Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients.

By Kamyar Kalantar-Zadeh, N. Kuwae, D. Regidor, C. Kovesdy, R. Kilpatrick, C. S. Shinaberger, C. J. Mcallister, M. Budoff, I. Salusky, J. Kopple. Kidney International, 2006

921 citations recorded by the source corpus.

Although renal osteodystrophy and vitamin D analogs may be related to survival in maintenance hemodialysis (MHD) patients, most studies have examined associations between baseline values and survival without accounting for variations in clinical and laboratory measures over time. We examined associations between survival and quarterly laboratory values and administered paricalcitol in a 2-year (July 2001-June 2003) cohort of 58,058 MHD patients from all DaVita dialysis clinics in USA using both time-dependent Cox models with repeated measures and fixed-covariate Cox models with only baseline values. Whereas hypercalcemia and hyperphosphatemia were robust predictors of higher death risk in all models, the association between serum calcium and mortality was different in time-varying models. Changes in baseline calcium and phosphorus values beyond the Kidney Disease Outcome Quality Initiative recommended targets were associated with increased mortality. Associations between high serum parathyroid hormone and increased death risk were masked by case-mix characteristics of MHD patients. Time-varying serum alkaline phosphatase had an incremental association with mortality. Administration of any dose of paricalcitol was associated with improved survival in time-varying models. Controlling for nutritional markers may introduce overadjustment bias owing to their strong collinearity with osteodystrophy surrogates. Whereas both time-dependent and fixed-covariate Cox models result in similar associations between osteodystrophy indicators and survival, subtle but potentially clinically relevant differences between the two models exist, probably because fixed models do not account for variations of osteodystrophy indices and changes in medication dose over time.

Subfields: Nephrology, Pathology and Forensic Medicine, Pediatrics, Perinatology and Child Health

View Paper: https://www.semanticscholar.org/paper/f97f5e67483ed6df20615b6d6a7fedfc491d0984

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(Transl.) D.D. Ivanov
(Transl.) M.D. Ivanova

Citations in the corpus

KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) (2017, result): “This finding is in line with the previously found U-shaped relation of phosphate with mortality risk in dialysis patients.(58) However, a recent trial comparing placebo with active phosphate-binder therapy in predialysis patients (CKDG3b–G4) with amean baseline phosphate concentration of 4.”
KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) (2009, neutral): “Coburn, 2004121 USA 78 (86) 44 (36) African American 48 (54) Caucasian 4 (11) Hispanic 4 (0) Other 3-4 nd Ca 2.”