NDT Advance Access originally published online on June 27, 2007
Nephrology Dialysis Transplantation 2007 22(10):2944-2949; doi:10.1093/ndt/gfm319
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Disturbed mineral metabolism is associated with muscle and skin complaints in a prospective cohort of dialysis patients
1Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, 2Hans Mak Institute, Naarden, 3Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, 4Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden and 5Department of Nephrology, Academic Medical Centre, University of Amsterdam, the Netherlands, 6Apperloo AJ, Bijlsma JA, Boekhout M, Boer WH, Boog PJM van der, Büller HR, Buren M van, Charro FTh de, Doorenbos CJ, Dorpel MA van den, Es A van, Fagel WJ, Feith GW, Fijter CWH de, Frenken LAM, Grave W, Geelen JACA van, Gerlag PGG, Gorgels JPMC, Huisman RM, Jager KJ, Jie K, Koning-Mulder WAH, Koolen MI, Kremer Hovinga TK, Lavrijssen ATJ, Luik AJ, Parlevliet KJ, Raasveld MHM, Sande FM van der, Schonck MJM, Schuurmans MMJ, Siegert CEH, Stegeman CA, Stevens P, Thijssen JGP, Valentijn RM, Vastenburg GH, Verburgh CA, Verstappen VMC, Vincent HH and Vos PF
Correspondence and offprint requests to: Marlies Noordzij, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. Email: m.noordzij{at}amc.uva.nl
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Abstract |
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Background. Disturbed mineral metabolism is associated with increased morbidity and mortality, however, its influence on physical symptoms is less clear. We explored the effects of disordered plasma calcium, phosphorus, calcium-phosphorus (Ca x P) product and intact parathyroid hormone (iPTH) concentrations according to the K/DOQI guideline for bone metabolism and disease on the risk of muscle and skin complaints in dialysis patients.
Methods. As part of NECOSAD, a prospective multicentre study in the Netherlands, we included 1469 consecutive patients who started haemodialysis or peritoneal dialysis between 1997 and 2004. Muscle pain, cramps and itching (pruritus) and dry (xerosis) skin were repeatedly measured using the Kidney Disease Quality of Life-Short Form questionnaire. Odds ratios (OR) for the risk of complaints over time were calculated by generalized estimating equations (GEE) models.
Results. Mean age was 59 ± 15 years, 61% of the patients were male and 63% were on haemodialysis. At baseline >65% of the patients had muscle and skin complaints. Compared with patients who met the target, the risk of muscle pain was increased in patients with hyperphosphataemia [OR: 1.2; 95% confidence interval (CI): 1.1–1.5] iPTH concentrations below the target range were associated with lower risk of cramps (OR 0.8, 95%CI: 0.6–0.9). The risk of pruritus was increased in patients with severely elevated plasma calcium (OR 1.4; 95%CI: 1.1–1.7), phosphorus (OR 1.4; 95%CI: 1.1–1.7) and Ca x P product levels (OR 1.6; 95%CI: 1.3–2.0). Finally, increased plasma calcium concentrations were associated with an elevated risk of xerosis (OR 1.4; 95%CI: 1.1–1.9).
Conclusions. Disturbed mineral metabolism according to the K/DOQI guideline is associated with more muscle and skin complaints in dialysis patients. These findings emphasize the importance of keeping mineral metabolism in dialysis patients in tight control.
Keywords: calcium; dialysis; mineral metabolism; muscle complaints; phosphorus; skin complaints
Received for publication: 9. 1.07
Accepted in revised form: 2. 5.07
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