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Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients.

Abstract：

BACKGROUND:The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time. METHODS:We employed a Cox model using up-to-5-year (7/2001-6/2006) time-averaged values to examine the mortality-predictability of cumulative serum calcium levels in 107,200 hemodialysis patients prior to the use of calcimimetics, but during the time where other calcium-lowering interventions, including lower dialysate calcium, were employed. RESULTS:Both low (<9.0 mg/dl) and high (>10.0 mg/dl) calcium levels were associated with increased mortality (reference: 9.0 to <9.5 mg/dl). Whereas mortality of hypercalcemia was consistent, hypocalcemia mortality was most prominent with higher serum phosphorus (>3.5 mg/dl) and PTH levels (>150 pg/ml). Higher paricalcitol doses shifted the calcium range associated with the greatest survival to the right, i.e. from 9.0 to <9.5 to 9.5 to <10.0 mg/dl. African-Americans exhibited the highest death hazard ratio of hypocalcemia <8.5 mg/dl, being 1.35 (95% CI: 1.22-1.49). Both a rise and drop in serum calcium over 6 months were associated with increased mortality compared to the stable group. CONCLUSIONS:Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.

journal_name

Am J Nephrol

journal_title

American journal of nephrology

authors

Miller JE,Kovesdy CP,Norris KC,Mehrotra R,Nissenson AR,Kopple JD,Kalantar-Zadeh K

doi

10.1159/000319861

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

403-13

issue

5

eissn

0250-8095

issn

1421-9670

pii

000319861

journal_volume

32

pub_type

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