NDT Advance Access originally published online on April 15, 2009
Nephrology Dialysis Transplantation 2009 24(9):2859-2865; doi:10.1093/ndt/gfp170
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Interaction between parathyroid hormone and the Charlson comorbidity index on survival of incident haemodialysis patients
1 Renal Division, A.O. Rummo, 82100 Benevento 2 Renal Division, Università ‘Sapienza’, 00161 Roma 3 Renal Division, University Federico II, 80131 Napoli 4 Renal Division, PO Lastaria, 71036 Lucera 5 Renal Division, A.O. San Paolo Polo Universitario, Milano 6 Renal Division, A.O. Sant’ Orsola Malpighi, 40138 Bologna 7 Renal Division, Dialisi Territoriale, 09100 Cagliari 8 Renal Division, A.O. Istituti Ospitalieri, 26100 Cremona 9 Renal Division, PO Nostra Signora di Bonaria, 09025 S. Gavino Monreale 10 Renal Division, P.O. Campo San Piero, 35100 Padova 11 Renal Division, Azienda Universitaria Ospedaliera Policlinico, 70124 Bari 12 Renal Division, Università degli Studi di Messina, 98128 Messina, Italy
Correspondence and offprint requests to: Luigi Francesco Morrone; E-mail: l.morrone{at}fastwebnet.it
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Abstract |
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Background. Haemodialysis patients are ageing and have with a high rate of comorbidities. The impact of this novel clinical setting on intact parathyroid hormone (iPTH) is not well established.
Methods. For this observational, prospective multicentre cohort study, incident haemodialysis patients were recruited in 40 Italian centres and followed up for a mean period of 18 ± 6.7 months. Clinical characteristics and biochemistry were recorded at baseline. Comorbid conditions were scored by the Charlson comorbidity index (CCI).
Results. Data of 411 patients (mean age: 66.5 ± 14.8 years; 17.3% >80 years old) were recorded. The mean CCI was 4.17 ± 2.8. In patients with CCI >0, an inverse correlation was observed between CCI (excluding age) and iPTH (P = 0.00002). Independently of CCI, patients with iPTH <150 pg/ml had 76% as high as the risk of all-cause mortality. After multivariable adjustment, the combination of the first tertile of iPTH with second and third tertiles of CCI was significantly associated with all-cause mortality (RR = 3.83, P = 0.02; RR = 3.79, P = 0.01, respectively).
Conclusions. Incident haemodialysis patients suffer from a high rate of clinical complications. In these patients, low iPTH and high CCI are often associated and very likely responsible for an adverse outcome.
Keywords: Charlson index; elderly; incident ESRD patients; intact parathyroid hormone; survival
* Investigators of the CPCP (‘Comorbidity–Parathormone–Calcium–Phosphate’) study, belonging to the ‘Mineral Metabolism and Trace Elements’ study group of the Italian Society of Nephrology, are listed in the Appendix.
Received for publication: 8.11.08
Accepted in revised form: 23. 3.09