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NDT Advance Access originally published online on May 27, 2009
Nephrology Dialysis Transplantation 2009 24(10):3151-3157; doi:10.1093/ndt/gfp260
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© The Author [2009]. Published by Oxford University Press [on behalf of ERA-EDTA].
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


The association between parathyroid hormone and mortality in dialysis patients is modified by wasting

Christiane Drechsler1,2, Vera Krane1, Diana C Grootendorst2, Eberhard Ritz3, Karl Winkler4, Winfried März5, Friedo Dekker2, Christoph Wanner1 and for the German Diabetes and Dialysis Study Investigators1

1 Division of Nephrology, Department of Medicine, University of Würzburg, Germany 2 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands 3 Division of Nephrology, Department of Medicine, University of Heidelberg 4 Department of Clinical Chemistry, University of Freiburg 5 Synlab Laboratory Diagnostics, Heidelberg, Germany

Correspondence and offprint requests to: Christiane Drechsler; E-mail: drechsler_c{at}medizin.uni-wuerzburg.de



  Abstract

Background. The association between parathyroid hormone (PTH) level and mortality in dialysis patients is controversial. We hypothesized that wasting, a common condition potentially related to adynamic bone disease, modifies the association of PTH with mortality and cardiovascular events (CVE), respectively.

Methods. We analysed data from 1255 diabetic haemodialysis patients, participating in the German Diabetes and Dialysis Study between 1998 and 2004. The patients were stratified by the presence or absence of wasting (albumin ≤3.8 versus albumin >3.8 g/dL; BMI ≤23 versus BMI >23 kg/m2). Using Cox regression analyses, we calculated the risks of (1) all-cause mortality and (2) CVE according to baseline PTH levels. All analyses were adjusted for age, sex, atorvastatin treatment, duration of dialysis, comorbidity, HbA1c, phosphate, calcium, blood pressure, haemoglobin and C-reactive protein.

Results. Patients had a mean age of 66 ± 8 years, and 54% were male. Among patients without wasting (albumin >3.8 g/dL, n = 586), the risks of death and CVE during 4 years of follow-up significantly increased by 23% and 20% per unit increase in logPTH. Patients in the highest PTH tertile had a 74% higher risk of death (HRadj 1.74, 95% CI 1.27–2.40) and a 49% higher risk of CVE (HRadj 1.49, 95% CI 1.05–2.11) compared to patients in the lowest PTH tertile. In contrast, no effect was found in patients with wasting. Accordingly, additional analyses in strata of BMI showed that PTH significantly impacted on death and CVE [HR(logPTH)adj 1.15 and 1.14, respectively] only in patients without, but not in patients with, wasting.

Conclusions. Wasting modifies the association of PTH with adverse outcomes in diabetic dialysis patients. High PTH levels are of concern in the patients without wasting, while the effect of PTH on mortality is nullified in the patients with wasting.

Keywords: cardiovascular events; haemodialysis; mortality; parathyroid hormone; wasting

Received for publication: 24. 3.09
Accepted in revised form: 7. 5.09


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