Abnormal bone dynamics is a major risk factor for cardiovascular disease in patients with chronic kidney disease. The level of serum intact parathyroid hormone (iPTH) is widely used as a bone dynamic marker. We investigated the effect of the mean level of serum iPTH on overall mortality and cardiovascular outcomes in incident dialysis patients.
Chronic kidney disease–mineral bone disorder (CKD–MBD) is a major risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). CKD–MBD is classified as low- or high-turnover bone disease according to the bone dynamics; both are related to vascular calcification in ESRD. To evaluate the prognostic value of abnormal serum parathyroid hormone (PTH) levels on ESRD patients, we investigated the effects of time-averaged serum intact PTH (TA-iPTH) levels on overall mortality and major adverse cardiac and cerebrovascular events (MACCEs) in incident dialysis patients.
Four hundred thirteen patients who started dialysis between January 2009 and September 2013 at Yonsei University Health System were enrolled. The patients were divided into three groups according to TA-iPTH levels during the 12 months after the initiation of dialysis: group 1, <65 pg/ml; group 2, 65–300 pg/ml; and group 3, >300 pg/ml. Cox regression analyses were performed to determine the prognostic value of TA-iPTH for overall mortality and MACCEs.
The mean age of the patients was 57 ± 15 years, and 222 patients (54 %) were men. During the median follow-up of 40.8 ± 29.3 months, 49 patients (12 %) died, and MACCEs occurred in 55 patients (13 %). The multivariate Cox regression analyses demonstrated that a low TA-iPTH level was an independent risk factor for both overall mortality (group 2 as reference; group 1: hazard ratio (HR) = 2.06, 95 % confidence interval (CI) = 1.11–3.83, P = 0.023) and MACCEs (HR = 1.82, 95 % CI = 1.04–3.20, P = 0.036) in incident dialysis patients after adjustment for confounding factors.
Low serum TA-iPTH is a useful clinical marker of both overall mortality and MACCEs in patients undergoing incident dialysis, mediated by vascular calcification.
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Chronic kidney disease–mineral bone disorder
End-stage renal disease
Time-averaged serum intact PTH
Major adverse cardiac and cerebrovascular events
Chronic kidney disease
Adynamic bone disease
Intact parathyroid hormone
Aortic arch calcification score
Yonsei University Health System
Body mass index
Area under the curve
Coefficient of variation
Aortic arch calcification
Acute coronary syndrome
Kidney Disease Outcomes Quality Initiative
Multi-Ethnic Study of Atherosclerosis
Bone-specific alkaline phosphatase
Bone mineral density
Electron beam computed tomography
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The present study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Yonsei University Health System (YUHS) Clinical Trial Center. We obtained written informed consent from all of the participants.
Conflicts of interest
Sul A Lee and Mi Jung Lee contributed equally to this work.
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Lee, S.A., Lee, M.J., Ryu, G.W. et al. Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients. Osteoporos Int 27, 2717–2726 (2016). https://doi.org/10.1007/s00198-016-3636-1