1. Prognosis and determinants of serum PTH changes over time in 1-5 CKD stage patients followed in tertiary care
- Author
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Mario Cozzolino, Roberto Minutolo, Michele Provenzano, Anna Maria Costanzo, Claudio Ronco, Giuseppe Conte, Paolo Chiodini, Carlo Garofalo, Giuliana Gualberti, Luca De Nicola, Carlo Manno, Silvio Borrelli, Giuseppe Remuzzi, Borrelli, Silvio, Chiodini, Paolo, De Nicola, Luca, Minutolo, Roberto, Provenzano, Michele, Garofalo, Carlo, Remuzzi, Giuseppe, Ronco, Claudio, Cozzolino, Mario Gennaro, Manno, Carlo, Costanzo, Anna Maria, Gualberti, Giuliana, and Conte, Giuseppe
- Subjects
Nephrology ,Male ,European People ,030232 urology & nephrology ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Biochemistry ,Tertiary Care Centers ,0302 clinical medicine ,Endocrinology ,Chronic Kidney Disease ,Medicine and Health Sciences ,Ethnicities ,Prospective Studies ,Prospective cohort study ,lcsh:Science ,Aged, 80 and over ,Multidisciplinary ,Middle Aged ,Prognosis ,Italian People ,Survival Rate ,Chemistry ,Proteinuria ,Bioassays and Physiological Analysis ,Quartile ,Italy ,Parathyroid Hormone ,Cohort ,Physical Sciences ,Female ,Cohort study ,Research Article ,Adult ,medicine.medical_specialty ,Endocrine Disorders ,Urology ,Research and Analysis Methods ,Disease-Free Survival ,Phosphates ,03 medical and health sciences ,Signs and Symptoms ,Diagnostic Medicine ,Internal medicine ,medicine ,Diabetes Mellitus ,Humans ,Survival rate ,Aged ,Renal Analysis ,Proportional hazards model ,business.industry ,lcsh:R ,Chemical Compounds ,Biology and Life Sciences ,medicine.disease ,Hormones ,Bone Diseases, Metabolic ,Metabolic Disorders ,People and Places ,Kidney Failure, Chronic ,Population Groupings ,lcsh:Q ,business ,Kidney disease ,Follow-Up Studies - Abstract
International Guidelines for mineral bone disorders recommend that in Non Dialytic-Chronic Kidney Disease (ND-CKD) clinical decisions should be based on the trend of serum PTH changes over time rather than on a single value. However, the prognostic impact of these changes in ND-CKD patients remains unknown. We performed a multicenter cohort study in ND-CKD patients (stage 1-5) followed for 36 months in 24 Italian Nephrology Units. PTH changes (ΔPTH) were defined as the absolute differences between all available PTH measurements following the first control and basal value. Primary endpoint in this subanalysis was renal death (End-Stage Renal Disease (ESRD) or all-causes death before ESRD). Association between renal death and ΔPTH was assessed by time-dependent Cox model for repeated measurements. Out of the original cohort (N = 884), we selected 543 patients (66.3±15.4 ys, 58.4% males) with at least two serum PTH measurements. At baseline, eGFR was 36 (IQR: 22.4-56.8) mL/min/1.73m2 and serum PTH 46 (IQR: 28-81) pg/mL. ΔPTH was in median 0 (IQR:-18/18) pg/mL. Basal predictors of longitudinal PTH increments were higher serum phosphate, more advanced CKD stages and lower serum PTH. Fully adjusted Cox model with ΔPTH quartiles as discrete time-dependent covariate showed a significant risk of renal death in the highest quartile (HR: 1.91; 95%CI:1.08-3.38; P = 0.026). Considering ΔPTH, as continuous time-dependent variable, (HR:1.02; 95%C.I.: 1.01-1.04; P = 0.004), risk of renal death progressively rose as ΔPTH increased. An increment in serum PTH over time is associated with a worse prognosis in ND-CKD patients, independently from baseline or any absolute concentration of serum PTH and phosphate.
- Published
- 2018