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NDT Advance Access published online on February 22, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh732
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received May 12, 2004
Accepted January 14, 2005

Original Articles

Mineral metabolism and haemoglobin concentration among haemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Naoki Kimata 1, Takashi Akiba 1, Ronald L. Pisoni 2, Justin M. Albert 2, Sudtida Satayathum 2, José M. Cruz 3, Tadao Akizawa 4, Vittorio E. Andreucci 5, Eric W. Young 6, and Friedrich K. Port 2*

1 Division of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
2 University Renal Research and Education Association, Ann Arbor, MI, USA
3 Hospital General Universitario ‘La Fe’ Servicio de Nefrología, Valencia, Spain
4 Center of Blood Purification Therapy, Wakayama Medical University, Wakayama, Japan
5 Cattedra di Nefrologia, Universitá Federico II di Napoli, Naples, Italy
6 Division of Nephrology, University of Michigan, Department of Veterans Affairs Medical Center, Ann Arbor, MI, USA

* To whom correspondence should be addressed.
Friedrich K. Port, E-mail: fport{at}urrea.org



  Abstract

Background. Bone and mineral metabolism is abnormal in most chronic haemodialysis patients and is associated with a high mortality risk. Because of possible pathogenic links between anaemia and intact parathyroid hormone (iPTH), the present study evaluated associations of mineral metabolism indicators with haemoglobin (Hb).

Methods. Data were collected from 317 facilities (12 089 haemodialysis patients) in Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the United Kingdom and the United States by the Dialysis Outcomes and Practice Patterns Study (DOPPS). The major outcome studied was probability of haemodialysis patients having a target Hb, per guidelines, of ≥11 g/dl at baseline. Major predictor variables were patient characteristics and laboratory markers of mineral metabolism: albumin-corrected serum calcium (calciumAlb), serum phosphorus (PO4) and iPTH. Analyses were adjusted for demographics, 15 comorbidity classes, baseline laboratory values, body mass index, years on dialysis, erythropoietin dose, vitamin D and catheter use, cause of end-stage renal disease and country.

Results. The adjusted odds ratio (AOR) of having Hb ≥11 g/dl was significantly higher (P<0.0001) in patients with higher calciumAlb (AOR = 1.32 per 1 mg/dl), higher PO4 (AOR = 1.08 per 1 mg/dl) and lower iPTH (AOR = 0.96 per 100 pg/ml). Furthermore, 4 month intrapatient changes in Hb concentration were significantly (P<0.0001) related to 4 month changes in calciumAlb (0.17 g/dl Hb rise per 1 mg/dl higher calciumAlb) and PO4 (0.11 g/dl Hb rise per 1 mg/dl higher PO4). Mean weekly recombinant human erythropoietin (rHuEpo) doses were higher for patients with high PO4 or iPTH levels, but lower for patients with calciumAlb >9.5 mg/dl, after patient mix and Hb concentration adjustments.

Conclusions. The results of this study indicate that higher serum calciumAlb and PO4 levels are each independently associated with better anaemia control. This relationship is independent of vitamin D use, PTH levels and prescribed rHuEpo dose. Despite this benefit of better anaemia control at higher serum calciumAlb and PO4 concentrations, lower calcium and PO4 levels, as recommended by the K/DOQI guidelines, should still serve as the long-term goal for HD patients in order to minimize tissue calcification and mortality risk.

Keywords: calcium and anaemia; haemodialysis guidelines; parathyroid hormone and anaemia; parathyroidectomy; phosphorus and anaemia; practice patterns.
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