NDT Advance Access published online on June 24, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl257
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1 Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
* To whom correspondence should be addressed. Background. The K/DOQI guideline for bone metabolism and disease in chronic kidney disease is predominantly based on studies in haemodialysis (HD) patients. However, in clinical practice, this guideline is also applied to peritoneal dialysis (PD) patients. To validate the implementation of this guideline in PD patients, we evaluated the associations between plasma concentrations outside the K/DOQI-targets and the risk of cardiovascular morbidity and mortality in incident PD patients compared with HD patients. Methods. In a large prospective multicentre study in the Netherlands (The Netherlands Cooperative Study on the Adequacy of Dialysis, NECOSAD), we included patients starting PD or HD between 1997 and 2004. Relative risk of cardiovascular morbidity and mortality were estimated using time-dependent Cox regression modelling. Results. We included 586 PD patients with mean age 52 ± 15 years (66% males) and 1043 HD patients with mean age 63 ± 14 years (58% males). Cardiovascular disease (CVD) was the reason for hospitalization in 102 PD and 271 HD patients. In HD patients, the relative risk of CVD-related hospitalization increased with elevated plasma calcium concentrations (hazard ratio: 1.4; 95% CI: 1.1-1.9). Cardiovascular mortality was significantly higher for phosphorus concentrations above the K/DOQI-threshold in PD (2.4; 95% CI: 1.3-4.2) and HD patients (1.5; 95% CI: 1.1-2.1), and for elevated Ca x P in PD (2.2; 95% CI: 1.3-3.8) and HD patients (1.5; 95% CI: 1.1-2.1). Conclusions. Plasma calcium concentrations above the K/DOQI-threshold increase the relative risk of CVD-related hospitalization in HD patients. Associations with cardiovascular mortality were more pronounced. Both in PD and HD patients with elevated plasma phosphorus and Ca x P concentrations, the cardiovascular mortality risk is increased. Therefore, it seems appropriate to adopt the current guideline in PD patients.
Received January 30, 2006
Accepted April 12, 2006
Original Article
Mineral metabolism and cardiovascular morbidity and mortality risk--peritoneal dialysis patients compared with haemodialysis patients
Marlies Noordzij 1 *,
Johanna C. Korevaar 1,
Willem J. Bos 2,
Elisabeth W. Boeschoten 3,
Friedo W. Dekker 4,
Patrick M. Bossuyt 1,
Raymond T. Krediet 5,
and
for the NECOSAD Study Group
2 Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
3 Hans Mak Institute, Naarden, The Netherlands
4 Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
5 Department of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Marlies Noordzij, E-mail: m.noordzij{at}amc.uva.nl
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