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Low parathyroid hormone level predicts infection-related mortality in incident dialysis patients: a prospective cohort study

Authors
 Yu Ah Hong  ;  Jeong Ho Kim  ;  Yong Kyun Kim  ;  Yoon Kyung Chang  ;  Cheol Whee Park  ;  Suk Young Kim  ;  Yon Su Kim  ;  Shin-Wook Kang  ;  Nam-Ho Kim  ;  Yong-Lim Kim  ;  Chul Woo Yang 
Citation
 KOREAN JOURNAL OF INTERNAL MEDICINE, Vol.35(1) : 160-170, 2020-01 
Journal Title
KOREAN JOURNAL OF INTERNAL MEDICINE
ISSN
 1226-3303 
Issue Date
2020-01
MeSH
Calcium ; Humans ; Parathyroid Hormone ; Peritoneal Dialysis* ; Prospective Studies ; Renal Dialysis* / adverse effects ; Republic of Korea
Keywords
Parathyroid hormone ; Infection ; Mortality ; Dialysis
Abstract
Background/Aims: Parathyroid hormone (PTH) is an important factor influencing immunologic dysfunction, but the effect of PTH level on infection-related outcomes remains unclear in incident dialysis. Methods: We evaluated a multicenter prospective cohort study of 1,771 incident dialysis patients (1,260 hemodialysis and 511 peritoneal dialysis) in Korea. Patients were divided into three groups based on serum intact PTH (iPTH) level. The primary outcomes were all-cause and infection-related mortality and multivariate Cox regression analysis was performed to evaluate the role of iPTH in all-cause and infection-related mortality. Results: During the follow-up period of 27.3 months, 175 patients (9.9%) died, and infection-related death represented 20% of all-cause mortality. Both all-cause mortality and infection-related mortality rates (p < 0.001 and p = 0.003, by log-rank) were markedly higher in patients with serum iPTH < 1.50 pg/mL than in the other groups. Multivariate Cox regression analysis revealed that patients with serum iPTH < 150 pg/mL remained at higher risk for infection-related mortality than patients in the target range of 150 <= iPTH < 300 pg/mL, after adjusting for confounding variables (hazard ratio [HR], 2.52; 95% confidence interval, 1.06 to 5.99; p = 0.04). The HR of infection-related mortality in patients with serum iPTH < 150 pg/mL was significantly higher in patients with low serum phosphorus, low Ca x P product, low serum alkaline phosphatase and those older than 65 years. Conclusions: Low serum iPTH level is an independent predictor of infection-related mortality in incident dialysis patients.
Files in This Item:
T9992020514.pdf Download
DOI
10.3904/kjim.2018.264
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190289
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