INTRODUCTION AND AIMS: The number of elderly patients often affected by multiple comorbidities is increasingly growing in incident chronic dialysis population. However, there is a lack of knowledge about the potential nearness between such epidemiologic changes and mineral metabolism disturbances.Aim of the study was to evaluate the frequency of parathyroid and mineral metabolism disorders among incident chronic dialysis patients,correlating such changes with the comorbidity rate. METHODS: We conducted a cross-sectional observational study which involved 37 italian hemodialysis units.Each center collected data from consecutive adult patients admitted in dialysis program during the last year due to the failure of the native kidney function. We gathered data from 364 incident chronic dialysis patients(age 64 ± 15 years,65% male, 37% with diabetic and/or hypertensive nephropathy, 8% in peritoneal dialysis). The comorbidity rate was evaluated with the Charlson Index, a validate score which includes a number of chronic diseases affecting different organs. RESULTS: More than 25% of incident dialysis patients were older than seventy-five and 14.3% were older than eighty. The Charlson index was 4.01 ± 2.89. At dialysis beginning, only 27% of patients had the intact parathormone (iPTH) circulating levels ranging from 150 and 300 pg/ml, while 73% were out of such K-DOQI target range. The changes of the mineral metabolism and important parathyroid disorder conditions were far from uncommon: iPTH < 100 pg/ml was present in 22.3% and iPTH > 500 pg/ml was present in 16.5% of patients. In less than the half of the patients, the corrected blood calcium fell within the target range 8.4 -9.5 mg/dl: 39% were above and 14% below such a blood calcium range. In addition, a phosphatemia > 5.5 mg/dl was present in 36% of cases. In those patients who presented comorbidities, the Charlson score showed a significant inverse relationship with iPTH (r -0.17, P=0.002). Further, Charlson index, age, phosphatemia, corrected calcemia and administration of vitamin D analogues were significantly and independently associated with iPTH levels (P=0.009) by multiple regression analysis. CONCLUSIONS: The incident chronic dialysis population is characterized by a high comorbidity rate and has often already severe disturbances of PTH secretion and mineral metabolism. In comorbid patients, the Charlson index was independently and significantly associated with low levels of circulating iPTH. Session: Poster: Bone and mineral metabolism - CKD - 1
IN INCIDENT CHRONIC DIALYSIS PATIENTS THE CHARLSON INDEX IS AN INDEPENDENT PREDICTOR OF LOW CIRCULATING PTH. AN ITALIAN MULTICENTRIC STUDY / Morrone, Luigi F.; Mazzaferro, Sandro; Cozzolino, Mario; Bolasco, Piergiorgio; Malberti, Fabio; Altieri, Paolo; Mereu, Maria C.; Schiavone, Palmira; Russo, Domenico; Dipalma, Teresa; Aucella, Filippo; Zazzera, Pierfelice; Stante, Silvio Di; Pertosa, Giovanni. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2007). (Intervento presentato al convegno ANNUAL MEETING ERA-EDTA June 21-24, Barcelona, Spain tenutosi a Barcelona, Spain nel June 21-24).
IN INCIDENT CHRONIC DIALYSIS PATIENTS THE CHARLSON INDEX IS AN INDEPENDENT PREDICTOR OF LOW CIRCULATING PTH. AN ITALIAN MULTICENTRIC STUDY
RUSSO, DOMENICO;
2007
Abstract
INTRODUCTION AND AIMS: The number of elderly patients often affected by multiple comorbidities is increasingly growing in incident chronic dialysis population. However, there is a lack of knowledge about the potential nearness between such epidemiologic changes and mineral metabolism disturbances.Aim of the study was to evaluate the frequency of parathyroid and mineral metabolism disorders among incident chronic dialysis patients,correlating such changes with the comorbidity rate. METHODS: We conducted a cross-sectional observational study which involved 37 italian hemodialysis units.Each center collected data from consecutive adult patients admitted in dialysis program during the last year due to the failure of the native kidney function. We gathered data from 364 incident chronic dialysis patients(age 64 ± 15 years,65% male, 37% with diabetic and/or hypertensive nephropathy, 8% in peritoneal dialysis). The comorbidity rate was evaluated with the Charlson Index, a validate score which includes a number of chronic diseases affecting different organs. RESULTS: More than 25% of incident dialysis patients were older than seventy-five and 14.3% were older than eighty. The Charlson index was 4.01 ± 2.89. At dialysis beginning, only 27% of patients had the intact parathormone (iPTH) circulating levels ranging from 150 and 300 pg/ml, while 73% were out of such K-DOQI target range. The changes of the mineral metabolism and important parathyroid disorder conditions were far from uncommon: iPTH < 100 pg/ml was present in 22.3% and iPTH > 500 pg/ml was present in 16.5% of patients. In less than the half of the patients, the corrected blood calcium fell within the target range 8.4 -9.5 mg/dl: 39% were above and 14% below such a blood calcium range. In addition, a phosphatemia > 5.5 mg/dl was present in 36% of cases. In those patients who presented comorbidities, the Charlson score showed a significant inverse relationship with iPTH (r -0.17, P=0.002). Further, Charlson index, age, phosphatemia, corrected calcemia and administration of vitamin D analogues were significantly and independently associated with iPTH levels (P=0.009) by multiple regression analysis. CONCLUSIONS: The incident chronic dialysis population is characterized by a high comorbidity rate and has often already severe disturbances of PTH secretion and mineral metabolism. In comorbid patients, the Charlson index was independently and significantly associated with low levels of circulating iPTH. Session: Poster: Bone and mineral metabolism - CKD - 1I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
