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Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease

  • S. Geng
  • Z. Kuang
  • P.L. Peissig
  • D. Page
  • L. Maursetter
  • K.E. HansenEmail author
Original Article

Abstract

Summary

Doctors do not know whether treatment of high parathyroid hormone levels is linked to better outcomes in their patients with kidney disease. In this study, lower parathyroid hormone levels at baseline were linked to lower risk of fracture, vascular events, and death in people with kidney disease.

Purpose

Chronic kidney disease (CKD) affects ~ 20% of older adults, and secondary hyperparathyroidism (HPT) is a common condition in these patients. To what degree HPT predicts fractures, vascular events, and mortality in pre-dialysis CKD patients is debated. In stage 3 and 4 CKD patients, we assessed relationships between baseline serum PTH levels and subsequent 10-year probabilities of clinical fractures, vascular events, and death.

Methods

We used Marshfield Clinic Health System electronic health records to analyze data from adult CKD patients receiving care between 1985 and 2013, and whose PTH was measured using a second-generation assay. Covariates included PTH, age, gender, tobacco use, vascular disease, diabetes, hypertension, hyperlipidemia, obesity, GFR, and use of osteoporosis medications.

Results

Five thousand one hundred eight subjects had a mean age of 68 ± 17 years, 48% were men, and mean follow-up was 23 ± 10 years. Fractures, vascular events, and death occurred in 18%, 71%, and 56% of the cohort, respectively. In univariate and multivariate models, PTH was an independent predictor of fracture, vascular events, and death. The hazards of fracture, vascular events and death were minimized at a baseline PTH of 0, 69, and 58 pg/mL, respectively.

Conclusions

We found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.

Keywords

Chronic kidney disease Fractures Mortality Secondary hyperparathyroidism Vascular events 

Notes

Acknowledgments

We thank Bryan Robeson, Technical Manager at Marshfield Clinic Laboratory for supplying information on the parathyroid assays used at Marshfield Clinic.

Compliance with ethical standards

Conflict of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of Computer SciencePrinceton UniversityPrincetonUSA
  2. 2.Computer Science DepartmentStanford UniversityStanfordUSA
  3. 3.Center for Computational and Biomedical InformaticsMarshfield Clinic Research InstituteMarshfieldUSA
  4. 4.Department of Biostatistics and Medical Informatics, Department of Computer SciencesUniversity of Wisconsin-MadisonMadisonUSA
  5. 5.Department of MedicineUniversity of Wisconsin School of Medicine & Public HealthMadisonUSA

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