Naslov
Detecting high-risk chronic kidney disease–mineral bone disorder phenotypes among patients on dialysis: a historical cohort study

Autori
Neri, Luca ; Kreuzberg, Ursula ; Bellocchio, Francesco ; Brancaccio, Diego ; Barbieri, Carlo ; Canaud, Bernard ; Stuard, Stefano ; Ketteler, Markus

Izvornik
Nephrology Dialysis Transplantation (0931-0509) 34 (2019), 4; 682-691

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
chronic kidney disease ; mineral bone disorder ; CKD-MBD

Sažetak
Background The clinical management of chronic kidney disease-mineral bone disorder (CKD-MBD) remains extremely challenging, partially due to difficulties in defining high-risk phenotypes based on serum biomarkers. We evaluated the prevalence and outcomes of 27 mutually exclusive CKD-MBD phenotypes in a large, multi-national cohort of chronic dialysis patients over a 5-year follow-up study. Methods In this historical cohort study, we enrolled all haemodialysis patients registered in EuCliD((R)) on 1 July 2011 across 28 Europe, the Middle East and Africa (EMEA) and South American countries. We created 27 mutually exclusive phenotypes based on combinations of serum parathyroid hormone (PTH), phosphorus (P) and calcium (Ca) 6-month averages (L, low ; T, target ; H, high). We tested the association between CKD- MBD phenotypes and 5-year mortality and hospitalization risk by outcome risk score- adjusted proportional hazard regression. Results We enrolled 35721 eligible patients. Eastern European and South American countries generally achieved poorer CKD-MBD control when compared with Western European countries (prevalence ratio: 0.79 ; P<0.001). There were 15795 deaths [126.7 deaths/1000 person-years ; 95% confidence interval (CI) 124.7-128.7] ; 18014 had at least one hospitalization (203.9 hospitalizations/1000 person-years ; 95% CI 201.0- 206.9) ; the incidence of the composite endpoint was 280.0 events/1000 person-years (95% CI 276.6- 283.5). In the fully adjusted model, relative mortality risk ranged from hazard ratio (HR)=1.07 (PTH/Ca/P: TLT) to HR=1.59 (PTH/Ca/P: LTL), whereas the relative composite endpoint risk ranged from HR=1.07 (PTH/Ca/P: TTH) to HR=1.36 (PTH/Ca/P: LTL). Conclusion We identified several CKD-MBD phenotypes associated with reduced hospitalization-free survival and increased mortality. Ranking of relative risk estimates or excess events concurs in informing healthcare priority setting.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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