Consistently maintaining certain blood levels of markers of bone metabolism and disease can prolong the lives of patients on hemodialysis, according to a study appearing in the September 2008 issue of the Clinical Journal of the American Society Nephrology (CJASN).
The findings indicate that keeping parathyroid hormone, calcium, and phosphorous levels in control is critically important for dialysis patients with chronic kidney disease (CKD).
Because mineral and bone disorder affects most patients with CKD, the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) has set specific treatment targets for the indicators of this disorder-serum levels of parathyroid hormone, calcium, and phosphorous. While research has shown that elevations in these markers are associated with increased morbidity and mortality in dialysis patients, no study has investigated the long-term control of these parameters.
Dr. Mark Danese of Outcomes Insights, Inc. (Newbury Park, CA), and his colleagues, Dr. Vasily Belozeroff and Dr. Karen Smirnakis of Amgen, Inc. (Thousand Oaks, CA) and Dr. Kenneth Rothman of Research Triangle Institute (Research Triangle Park, NC), set out to determine whether more consistent control of parathyroid, calcium, and phosphorous levels within the KDOQI target ranges is associated with improved survival. The study was conducted among 24,803 adults initiating dialysis between 2000 and 2002. The researchers assessed whether survival was improved when patients were within the three target levels simultaneously. They also examined whether survival was improved when patients were within each of the three target levels for prolonged periods of time.
The researchers reported that it was important to meet as many of the targets as possible at any given time. Meeting the target for none of the three markers was associated with a 51% higher risk of death compared with patients who achieved targets simultaneously for all three markers. Patients meeting only one target had a 35% to 39% increased risk of death, and patients meeting any two targets had a 15% to 21% higher risk of death.