Outcomes Associated with Serum Calcium Level in Men with Non-Dialysis-Dependent Chronic Kidney Disease
01 Mar 2010-Clinical Journal of The American Society of Nephrology (American Society of Nephrology)-Vol. 5, Iss: 3, pp 468-476
TL;DR: Clinical trials are warranted to determine whether maintaining normal serum calcium can improve outcomes in patients with NDD CKD, and higher serum calcium is associated with increased long-term mortality, and lower calcium isassociated with increased short-term death in patients in the time-varying models.
Abstract: Background and objectives: Elevated serum calcium has been associated with increased mortality in dialysis patients, but it is unclear whether the same is true in non-dialysis-dependent (NDD) chronic kidney disease (CKD). Outcomes associated with low serum calcium are also not well-characterized. Design, setting, participants, & measurements: We examined associations of baseline, time-varying, and time-averaged serum calcium with all-cause mortality in a historic prospective cohort of 1243 men with moderate and advanced NDD CKD by using Cox models. Results: The association of serum calcium with mortality varied according to the applied statistical models. Higher baseline calcium and time-averaged calcium were associated with higher mortality (multivariable adjusted hazard ratio (95% confidence interval): 1.31 (1.13, 1.53); P Conclusions: Higher serum calcium is associated with increased long-term mortality (as reflected by the baseline and time-averaged models), and lower serum calcium is associated with increased short-term mortality (as reflected by the time-varying models) in patients with NDD CKD. Clinical trials are warranted to determine whether maintaining normal serum calcium can improve outcomes in these patients.
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TL;DR: The combination of predialysis indices comprising age, overweight/obesity, anemia, and corrected calcium could provide a significant predictive value for technique failure of PD.
Abstract: Technique failure remains a frequent cause of peritoneal dialysis (PD) withdrawal Many post-commencement predictors of PD technique failure have been identified, while predialysis predictors have remained unclear The aim of this study was to identify predialysis indices for technique failure in PD patients We recruited 206 consecutive PD patients who were treated at Nara Medical University Hospital between 1 April 1997 and 31 December 2012 Forty-eight patients were excluded because of transition from hemodialysis (HD) or withdrawal from PD within 3 months, leaving 158 patients for analysis Clinical characteristics and laboratory data from within 3 months preceding PD commencement were analyzed The primary outcome was the composite of time to combined use of HD, transition to HD, and all-cause mortality within 2 years after PD commencement During the study period, the primary outcome was observed in 50 patients Using multivariate analysis, greater age (odds ratios (ORs) [95%CI], 308 [172-561]), anemia (ORs [95%CI], 212 [108-443]), overweight/obesity (ORs [95%CI], 209 [116-372]), and hypocalcemia (ORs [95%CI], 186 [104-335]) were independently associated with technique failure Adding corrected calcium to the model incorporating age, body mass index, and hemoglobin significantly increased the c-statistic from 0678 to 0755 (P = 0048) relative to the model incorporating age alone The integrated discrimination improvement was 0085 (95% CI 0036-0134, P < 0001) and the continuous net reclassification improvement was 0395 (95% CI 0066-0724, P = 002) In conclusion, the combination of predialysis indices comprising age, overweight/obesity, anemia, and corrected calcium could provide a significant predictive value for technique failure of PD
6 citations
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01 Nov 2014-Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia
TL;DR: Abnormalities of CKD related mineral and bone disorder, which includes elevated fibroblast growth factor 23 (FGF23) have been one of the most extensively studied, but the debate over the exact pathways by which FGF23 may lead to increased CVD still continues.
Abstract: The prevalence of chronic kidney disease (CKD) has now reached epidemic proportions and it is very likely that it will continue to rise with the increasing prevalence of juvenile diabetes mellitus, hypertension and aging population. CKD is a risk factor for cardiovascular disease (CVD) and cardiovascular disease can lead to CKD. It is also well known that patients with CKD have a higher risk of death from CVD than of progressing to end-stage renal disease that requires renal replacement therapy. In patients with CKD, there is a higher mortality from sudden cardiac death and congestive heart failure than coronary artery disease, which is not the case in the general population. The high prevalence of congestive heart failure in CKD is due to cardiac remodeling which progresses from concentric remodeling to concentric and eccentric hypertrophy, leading to left ventricular hypertrophy with both systolic and diastolic dysfunction. Recent studies have suggested that, in patients with chronic kidney disease, common traditional risk factors for cardiovascular disease such as hypertension, hyperlipidemia and obesity may not be the main determinants of cardiovascular disease. Among the various non-traditional cardiovascular risk factors present in patients with chronic kidney disease, abnormalities of CKD related mineral and bone disorder, which includes elevated fibroblast growth factor 23 (FGF23) have been one of the most extensively studied. However, after many years of research, the debate over the exact pathways by which FGF23 may lead to increased CVD still continues. FGF23 may have both direct and indirect effects on the cardiovascular system. Better understanding of the most relevant pathophysiologic pathways for FGF23 may lead to therapeutic interventions against cardiovascular disease in patients with CKD.
5 citations
24 Sep 2013
TL;DR: The value of non-traditional risk factors, like aortic valve calcification, ABO blood type, hemoglobin, blood transfusions and Body Mass Index, on postoperative and long-term outcome in patients undergoing non-cardiac surgery is evaluated and it is found that each of these risk factors contributed to adverse outcomes.
Abstract: textAtherothrombosis is a major worldwide health problem and will continue to be the leading cause of mortality in the next decade. By definition, patients undergoing vascular surgery have established atherothrombosis in one vascular bed. However the prevalence of polyvascular disease, defined as symptomatic involvement of more than one vascular bed, in these patients is high. For patients undergoing non-cardiac surgery, the risk of postoperative adverse cardiovascular events is estimated by the use of preoperative risk scores, particularly the Revised Cardiac Risk Index. We have evaluated the value of non-traditional risk factors, like aortic valve calcification, ABO blood type, hemoglobin, blood transfusions and Body Mass Index (BMI), on postoperative and long-term outcome in patients undergoing non-cardiac surgery and found that, except for ABO blood type, each of these risk factors contributed to adverse outcomes. Although the results of our studies suggest the use of these ‘novel’ risk factors in the estimation of the postoperative cardiovascular event and long-term mortality risk, it is probably most important to recognize and adequately treat the underlying comorbidity that is responsible for the negative outcomes, particularly coronary heart disease. Therefore, the primary focus for all patients with atherothrombotic disease should be on optimal risk factor control with medical therapy and lifestyle interventions according to guideline recommendations in order to prevent future cardiovascular events.
5 citations
TL;DR: In a recent study, the authors showed that females are ∼30% more likely to have pre-dialysis chronic kidney disease (CKD) than males for reasons that are not fully understood.
5 citations
TL;DR: This review discusses each abnormality separately, with references to both the Kidney Dialysis Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease and KDIGO Guidelines for Mineral and Bone Disorder.
Abstract: Chronic kidney disease–mineral and bone disorders (CKD-MBD) is a term introduced by the Kidney Disease: Improving Global Outcomes (KDIGO) work group on mineral and bone disorder as a syndrome of interrelated biochemical, bone, and vascular abnormalities encountered in CKD. Biochemical abnormalities in CKD represent primary indicators for the diagnosis and management of CKD-MBD. This review discusses each abnormality separately, with references to both the Kidney Dialysis Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease and KDIGO Guidelines for Mineral and Bone Disorder. Selected references to the association between biochemical abnormalities and adverse clinical outcomes in CKD population are provided.
4 citations
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TL;DR: The purpose of this study was to develop an equation from MDRD Study data that could improve the prediction of GFR from serum creatinine concentration, and major clinical decisions in general medicine, geriatrics, and oncology are made by using the Cockcroft-Gault formula and other formulas to predict the level of renal function.
Abstract: The serum creatinine concentration is widely used as an index of renal function, but this measure is affected by factors other than the glomerular filtration rate (GFR). This study examined an equa...
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"Outcomes Associated with Serum Calc..." refers methods in this paper
...(30) and was categorized according to the staging system introduced by...
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TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.
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TL;DR: In what case do you like reading so much? What about the type of the vitamin d the calcium homeostatic steroid hormone book? The needs to read? Well, everybody has their own reason why should read some books as discussed by the authors.
Abstract: In what case do you like reading so much? What about the type of the vitamin d the calcium homeostatic steroid hormone book? The needs to read? Well, everybody has their own reason why should read some books. Mostly, it will relate to their necessity to get knowledge from the book and want to read just to get entertainment. Novels, story book, and other entertaining books become so popular this day. Besides, the scientific books will also be the best reason to choose, especially for the students, teachers, doctors, businessman, and other professions who are fond of reading.
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Journal Article•
University of Southern California1, United States Department of Veterans Affairs2, University of California, San Francisco3, Washington University in St. Louis4, Children's Memorial Hospital5, University of Kentucky6, Saint Louis University7, Mayo Clinic8, Indiana University – Purdue University Indianapolis9, University of California, Los Angeles10, University of Virginia11
2,609 citations
TL;DR: Hyperphosphatemia and hyperparathyroidism were significantly associated with all-cause, cardiovascular, and fracture-related hospitalization, and the population attributable risk percentage for disorders of mineral metabolism was 17.5%, owing largely to the high prevalence of hyperph phosphatemia.
Abstract: Mortality rates in ESRD are unacceptably high. Disorders of mineral metabolism (hyperphosphatemia, hypercalcemia, and secondary hyperparathyroidism) are potentially modifiable. For determining associations among disorders of mineral metabolism, mortality, and morbidity in hemodialysis patients, data on 40,538 hemodialysis patients with at least one determination of serum phosphorus and calcium during the last 3 mo of 1997 were analyzed. Unadjusted, case mix-adjusted, and multivariable-adjusted relative risks of death were calculated for categories of serum phosphorus, calcium, calcium x phosphorus product, and intact parathyroid hormone (PTH) using proportional hazards regression. Also determined was whether disorders of mineral metabolism were associated with all-cause, cardiovascular, infection-related, fracture-related, and vascular access-related hospitalization. After adjustment for case mix and laboratory variables, serum phosphorus concentrations >5.0 mg/dl were associated with an increased relative risk of death (1.07, 1.25, 1.43, 1.67, and 2.02 for serum phosphorus 5.0 to 6.0, 6.0 to 7.0, 7.0 to 8.0, 8.0 to 9.0, and >/=9.0 mg/dl). Higher adjusted serum calcium concentrations were also associated with an increased risk of death, even when examined within narrow ranges of serum phosphorus. Moderate to severe hyperparathyroidism (PTH concentrations >/=600 pg/ml) was associated with an increase in the relative risk of death, whereas more modest increases in PTH were not. When examined collectively, the population attributable risk percentage for disorders of mineral metabolism was 17.5%, owing largely to the high prevalence of hyperphosphatemia. Hyperphosphatemia and hyperparathyroidism were significantly associated with all-cause, cardiovascular, and fracture-related hospitalization. Disorders of mineral metabolism are independently associated with mortality and morbidity associated with cardiovascular disease and fracture in hemodialysis patients.
2,475 citations
"Outcomes Associated with Serum Calc..." refers background in this paper
...Some of the same studies have also suggested that extremely low calcium levels may themselves be deleterious (2,3), which has ultimately resulted in recommendations to attain a low-normal serum calcium level in dialysis patients (23)....
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