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Calcium, Phosphorus, PTH |
LA Biomed at Harbor-UCLA Med Cntr,1 Torrance, California; VA Hosp,2 Salem, Virginia; DaVita,3 El Segundo, California, USA.
Objective: Hypercalcemia is independently related to increased death risk
in maintenance hemodialysis patients. However, these data may not be
extrapolated to chronic peritoneal dialysis (CPD) patients.
Methods: We examined a large and contemporary cohort of 7034 CPD patients
who underwent dialysis treatment for at least 3 months in a DaVita dialysis
clinic between July 2001 and June 2004. All serum calcium values measured
within a 3-month calendar quarter were averaged into 1 single value.
Results: Patients were 46.5±10.4 years old and included 48% women,
22% African Americans, 14% Hispanics, and 50% diabetics. Albumin adjusted
serum calcium was examined both as a continuous variable and as categorized
into 6 a priori selected groups of <8.5,
Conclusions: Hence, in CPD patients, hypercalcemia appears independently
associated with increase in death risk.
10.5, and 4 groups of
0.5 mg/dL increments in-between. In multivariate Cox models adjusted for
case-mix (gender, age, race, ethnicity, dialysis vintage, residual renal
function, and Kt/V) and malnutrition–inflammation complex (serum
creatinine, albumin, TIBC, WBC, phosphorus, PTH, lymphocyte percentage, and
blood hemoglobin), each 1-mg/dL increase in serum calcium was associated with
a death hazard ratio (HR) of 1.15 (95% CI: 1.07–1.23,
p<0.0001). The categorical calcium analysis exhibited a similar
trend: compared to 8.5 to <9.0 mg/dL, <8.5 mg/dL, HR 1.0 (0.83,1.21);
9.0 to <9.5 mg/dL, HR 1.11 (0.95,1.30); 9.5 to <10.0 mg/dL, HR 1.12
(0.94,1.32); 10.0 to <10.5 mg/dL, HR 1.20 (1.00,1.44) and 10.5 mg/dL,
HR 1.21 (0.99,1.47).
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