+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Association of Pre-ESRD Serum Calcium with Post-ESRD Mortality Among Incident ESRD Patients: a Cohort Study

Association of Pre-ESRD Serum Calcium with Post-ESRD Mortality Among Incident ESRD Patients: a Cohort Study

Journal of Bone and Mineral Research

Albumin-corrected serum calcium (cSCa) decline at late stages of chronic kidney disease and rise after dialysis initiation. While hypercalcemia is associated with higher mortality in end-stage renal disease (ESRD), there are scarce data on the impact of pre-ESRD cSCa on post-ESRD mortality. Therefore, we used a large national cohort of 21,826 US veterans with incident ESRD who transitioned to dialysis in all US Department of Veterans Affairs healthcare facilities over 2009-2014 to examine the associations with all-cause and cause-specific post-ESRD mortality of (1) cSCa concentrations averaged over the last six months and (2) its rate of decline during the last 12 months before dialysis initiation. Mean concentrations and median rate of decline of cSCa were 9.3 ± 0.7 mg/dL and -0.15 (interquartile range, -0.39 to 0.07) mg/dL/year, respectively. A total of 9,596 patients died during the follow-up period (mean 1.9 years; total 41,541 patient-years) with an incidence rate of 23.1 per 100 patient-years. There was an independent linear association between higher cSCa with higher mortality (Ptrend <0.001). The mortality risk associated with cSCa ≥9.0 mg/dL was attenuated amongst active vitamin D users (Pinteraction <0.001). Patients with faster decline in cSCa showed lower mortality irrespective of baseline cSCa concentrations. These cSCa-mortality associations were stronger for non-cardiovascular vs. cardiovascular death. In conclusion, lower pre-ESRD cSCa and faster decline in cSCa were consistently and linearly associated with better post-ESRD survival among US veterans, especially for non-cardiovascular death. Further studies are needed to determine if correcting hypocalcemia is beneficial or harmful and which intervention is preferred when indicated among patients with incident ESRD. This article is protected by copyright. All rights reserved.

(PDF emailed within 0-6 h: $19.90)

Accession: 051063302

Download citation: RISBibTeXText

PMID: 29342320

DOI: 10.1002/jbmr.3391

Related references

Pre-ESRD Dementia and Post-ESRD Mortality in a Large Cohort of Incident Dialysis Patients. Dementia and Geriatric Cognitive Disorders 43(5-6): 281-293, 2017

Pre-ESRD Care and Mortality in Incident ESRD Patients With Multiple Myeloma. American Journal of Clinical Oncology 41(4): 367-370, 2016

Impact of timing of nephrology referral, regular pre-ESRD care and exercise on mortality risk in incident ESRD patients. Journal of the American Society of Nephrology 12(Program and Abstract Issue): 249A, September, 2001

Pre-ESRD Depression and Post-ESRD Mortality in Patients with Advanced CKD Transitioning to Dialysis. Clinical Journal of the American Society of Nephrology 12(9): 1428-1437, 2017

Association of family history of ESRD, prevalent albuminuria, and reduced GFR with incident ESRD. American Journal of Kidney Diseases 59(1): 25-31, 2012

Methodological limitations of the ESRD Core Indicators Project: an ESRD network's experience with implementing an ESRD quality survey. Medical Review Board of the ESRD Network of New England. American Journal of Kidney Diseases 30(3): 349-355, 1997

The association of parathyroid hormone with ESRD and pre-ESRD mortality in the Kidney Early Evaluation Program. Journal of Clinical Endocrinology and Metabolism 97(12): 4414-4421, 2013

Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. American Journal of Kidney Diseases 41(2): 310-318, 2003

Lower Mortality in Living Kidney Donors With ESRD Versus Matched Nondonors With ESRD. Kidney International Reports 3(5): 1023-1024, 2018

Penultimate pulse wave velocity, better than baseline pulse wave velocity, predicted mortality in Italian ESRD cohort study - a case for daily hemodialysis for ESRD patients with accelerated pulse wave velocity changes. Giornale Italiano di Nefrologia 30(2): -, 2015

Projecting the United States ESRD population: issues regarding treatment of patients with ESRD. Kidney International. Supplement 2004(90): S3-S7, 2004

A comparison of rates of influenza and pneumococcal immunization in ESRD and non-ESRD patients. Journal of the American Society of Nephrology 11(Program and Abstract Issue): 157A, September, 2000

Promoting quality of care for ESRD patients: the role of the ESRD Networks. Advances in Renal Replacement Therapy 8(2): 138-143, 2001

Strategies for influencing outcomes in pre-ESRD and ESRD patients: a special conference. 1998. Proceedings. American Journal of Kidney Diseases 32(6 Suppl 4): S1-193, 1999

Limb salvage in end-stage renal disease (ESRD). Comparison of modern results in patients with and without ESRD. Archives of Surgery 123(9): 1164-1168, 1988