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Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients
BACKGROUND: Marked hyperphosphatemia, hyperparathyroidism and 25-hydroxyvitamin D deficiency are associated with mortality in dialysis patients. Such data in chronic kidney disease stage 2–4 population are limited. It has been suggested that high-normal serum phosphate predicts worse renal and patie...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551685/ https://www.ncbi.nlm.nih.gov/pubmed/23324569 http://dx.doi.org/10.1186/1471-2369-14-14 |
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author | Chartsrisak, Kamonwan Vipattawat, Kotcharat Assanatham, Montira Nongnuch, Arkom Ingsathit, Atiporn Domrongkitchaiporn, Somnuek Sumethkul, Vasant Distha-Banchong, Sinee |
author_facet | Chartsrisak, Kamonwan Vipattawat, Kotcharat Assanatham, Montira Nongnuch, Arkom Ingsathit, Atiporn Domrongkitchaiporn, Somnuek Sumethkul, Vasant Distha-Banchong, Sinee |
author_sort | Chartsrisak, Kamonwan |
collection | PubMed |
description | BACKGROUND: Marked hyperphosphatemia, hyperparathyroidism and 25-hydroxyvitamin D deficiency are associated with mortality in dialysis patients. Such data in chronic kidney disease stage 2–4 population are limited. It has been suggested that high-normal serum phosphate predicts worse renal and patient outcomes. The data regarding parathyroid hormone and outcomes in this population is limited. The present study examined mineral metabolism and its association with the development of end-stage renal disease and mortality in stage 2–4 chronic kidney disease patients. METHODS: This is a prospective cohort study that included 466 non-dialysis chronic kidney disease stage 2–4 patients. Mineral parameters were obtained at the time of enrollment and the patients were followed prospectively for 25 (1–44) months or until they reached the endpoints of end-stage renal disease or mortality. RESULTS: Hyperparathyroidism and 25-hydroxyvitamin D deficiency began to occur in the early stages of chronic kidney disease, whereas significant hyperphosphatemia only developed in the later stages. High-normal and mildly elevated serum phosphate (>4.2 mg/dL) predicted the composite outcome of end-stage renal disease or mortality after adjustments for cardiovascular risk factors, chronic kidney disease stage and other mineral parameters. Parathyroid hormone levels above the upper limit of normal (>65 pg/mL) predicted the future development of end-stage renal disease and the composite outcome of end-stage renal disease or mortality after adjustments. 25-hydroxyvitamin D deficiency (<15 ng/mL) was also associated with worse outcomes. CONCLUSIONS: In chronic kidney disease, hyperparathyroidism developed prior to significant hyperphosphatemia confirming the presence phosphate retention early in the course of chronic kidney disease. High-normal serum phosphate and mildly elevated parathyroid hormone levels predicted worse renal and patient outcomes. This data emphasizes the need for early intervention in the care of chronic kidney disease stage 2–4 patients. |
format | Online Article Text |
id | pubmed-3551685 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35516852013-01-24 Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients Chartsrisak, Kamonwan Vipattawat, Kotcharat Assanatham, Montira Nongnuch, Arkom Ingsathit, Atiporn Domrongkitchaiporn, Somnuek Sumethkul, Vasant Distha-Banchong, Sinee BMC Nephrol Research Article BACKGROUND: Marked hyperphosphatemia, hyperparathyroidism and 25-hydroxyvitamin D deficiency are associated with mortality in dialysis patients. Such data in chronic kidney disease stage 2–4 population are limited. It has been suggested that high-normal serum phosphate predicts worse renal and patient outcomes. The data regarding parathyroid hormone and outcomes in this population is limited. The present study examined mineral metabolism and its association with the development of end-stage renal disease and mortality in stage 2–4 chronic kidney disease patients. METHODS: This is a prospective cohort study that included 466 non-dialysis chronic kidney disease stage 2–4 patients. Mineral parameters were obtained at the time of enrollment and the patients were followed prospectively for 25 (1–44) months or until they reached the endpoints of end-stage renal disease or mortality. RESULTS: Hyperparathyroidism and 25-hydroxyvitamin D deficiency began to occur in the early stages of chronic kidney disease, whereas significant hyperphosphatemia only developed in the later stages. High-normal and mildly elevated serum phosphate (>4.2 mg/dL) predicted the composite outcome of end-stage renal disease or mortality after adjustments for cardiovascular risk factors, chronic kidney disease stage and other mineral parameters. Parathyroid hormone levels above the upper limit of normal (>65 pg/mL) predicted the future development of end-stage renal disease and the composite outcome of end-stage renal disease or mortality after adjustments. 25-hydroxyvitamin D deficiency (<15 ng/mL) was also associated with worse outcomes. CONCLUSIONS: In chronic kidney disease, hyperparathyroidism developed prior to significant hyperphosphatemia confirming the presence phosphate retention early in the course of chronic kidney disease. High-normal serum phosphate and mildly elevated parathyroid hormone levels predicted worse renal and patient outcomes. This data emphasizes the need for early intervention in the care of chronic kidney disease stage 2–4 patients. BioMed Central 2013-01-16 /pmc/articles/PMC3551685/ /pubmed/23324569 http://dx.doi.org/10.1186/1471-2369-14-14 Text en Copyright ©2013 Chartsrisak et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Chartsrisak, Kamonwan Vipattawat, Kotcharat Assanatham, Montira Nongnuch, Arkom Ingsathit, Atiporn Domrongkitchaiporn, Somnuek Sumethkul, Vasant Distha-Banchong, Sinee Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
title | Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
title_full | Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
title_fullStr | Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
title_full_unstemmed | Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
title_short | Mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
title_sort | mineral metabolism and outcomes in chronic kidney disease stage 2–4 patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551685/ https://www.ncbi.nlm.nih.gov/pubmed/23324569 http://dx.doi.org/10.1186/1471-2369-14-14 |
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