The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients

• Published in: Renal failure Vol. 43; no. 1; pp. 599 - 605
• Main Authors: Zhou, Xiaoling, Guo, Yidan, Luo, Yang
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.01.2021; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Cardiovascular diseases; Clinical Study; dialysis; Hemodialysis; Kidney diseases; Mortality; Parathyroid hormone; Regression analysis; Sensitivity analysis; dialysis; mortality; Parathyroid hormone
• ISSN: 0886-022X; 1525-6049
• DOI: 10.1080/0886022X.2021.1903927

The serum intact parathyroid hormone (iPTH) is associated with the prognosis of hemodialysis (HD) patients, however, its optimal range for reducing mortality remains inconsistent. We designed a prospective cohort study of 346 incident HD patients to assess the association between different serum iPTH level and mortality. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) international guidelines (2003), we divided patients into three groups (iPTH < 150 pg/mL, 150-300 pg/mL and >300 pg/mL). During the median follow-up of 58 months, 157 patients (45.38%) died. Multivariate Cox regression analysis showed that iPTH < 150 pg/mL and >300 pg/mL were associated with all-cause and cardiovascular mortality. Then, we performed a sensitivity analysis of patients divided into 6 serum PTH levels groups according to the folds of the K/DOQI target range. Multivariate Cox regression analysis showed that patients with serum iPTH ≥750 pg/mL, 600-749 pg/mL, 450-599 pg/mL had significantly higher risk of all-cause and cardiovascular mortality compared with those with serum iPTH in the range of 150-299 pg/mL. The association between serum iPTH and mortality shows a U-shaped curve. The optimal serum iPTH level which confers the lowest risk of all-cause and cardiovascular mortality could range from 150 pg/mL to 450 pg/mL in this group of incident HD patients.