@article{8c4cc23b5adb431aa8470ea3f4448192,
title = "Association of Mineral Bone Disorder With Decline in Residual Kidney Function in Incident Hemodialysis Patients",
abstract = "Abnormalities of mineral bone disorder (MBD) parameters have been suggested to be associated with poor renal outcome in predialysis patients. However, the impact of those parameters on decline in residual kidney function (RKF) is uncertain among incident hemodialysis (HD) patients. We performed a retrospective cohort study in 13,772 patients who initiated conventional HD during 2007 to 2011 and survived 6 months of dialysis. We examined the association of baseline serum phosphorus, calcium, intact parathyroid hormone (PTH), and alkaline phosphatase (ALP) with a decline in RKF. Decline in RKF was assessed by estimated slope of renal urea clearance (KRU) over 6 months from HD initiation. Our cohort had a mean ± SD age of 62 ± 15 years; 64% were men, 57% were white, 65% had diabetes, and 51% had hypertension. The median (interquartile range [IQR]) baseline KRU level was 3.4 (2.0, 5.2) mL/min/1.73 m2. The median (IQR) estimated 6-month KRU slope was −1.47 (−2.24, −0.63) mL/min/1.73 m2 per 6 months. In linear regression models, higher phosphorus categories were associated with a steeper 6-month KRU slope compared with the reference category (phosphorus 4.0 to <4.5 mg/dL). Lower calcium and higher intact PTH and ALP categories were also associated with a steeper 6-month KRU slope compared with their respective reference groups (calcium 9.2 to <9.5 mg/dL; intact PTH 150 to <250 pg/mL; ALP <60 U/L). The increased number of parameter abnormalities had an additive effect on decline in RKF. Abnormalities of MBD parameters including higher phosphorus, intact PTH, ALP and lower calcium levels were independently associated with decline in RKF in incident HD patients.",
keywords = "ALKALINE PHOSPHATASE, HEMODIALYSIS, PARATHYROID HORMONE, PHOSPHORUS, RESIDUAL KIDNEY FUNCTION",
author = "Lee, {Yu Ji} and Yusuke Okuda and John Sy and Yoshitsugu Obi and Kang, {Duk Hee} and Steven Nguyen and Hsiung, {Jui Ting} and Christina Park and Rhee, {Connie M.} and Kovesdy, {Csaba P.} and Elani Streja and Kamyar Kalantar-Zadeh",
note = "Funding Information: KKZ has been supported by the NIH/NIDDK mid-career award K24-DK091419. ES is supported by a career development award from the Office of Research and Development of the Department of Veterans Affairs (IK2-CX 001266-01). Authors' roles: Research idea and study design: YL, ES, and KKZ. Data acquisition: ES, CMR, and KKZ. Data analysis/interpretation: YL, YO, JS, YO, DK, SN, JTH, CP, CPK, ES, and KKZ. Drafting manuscript: YL. YO, JS, JTH, and CP. Supervision: ES and KKZ. Each author contributed important intellectual content during manuscript drafting or revision. Funding Information: KKZ has received honoraria and/or support from Abbott, Abbvie, Alexion, Amgen, American Society of Nephrology, Astra‐Zeneca, AVEO Oncology, Chugai, DaVita, Fresenius, Genentech, Haymarket Media, Hofstra Medical School, International Federation of Kidney Foundations, International Society of Hemodialysis, International Society of Renal Nutrition & Metabolism, Japanese Society of Dialysis Therapy, Hospira, Kabi, Keryx, Novartis, National Institutes of Health, National Kidney Foundation, OPKO, Pfizer, Relypsa, Resverlogix, Sandoz, Sanofi, Shire, Vifor, UpToDate, and ZSPharma. All other authors state that they have no conflicts of interest. Funding Information: KKZ has been supported by the NIH/NIDDK mid‐career award K24‐DK091419. ES is supported by a career development award from the Office of Research and Development of the Department of Veterans Affairs (IK2‐CX 001266‐01). Authors' roles: Research idea and study design: YL, ES, and KKZ. Data acquisition: ES, CMR, and KKZ. Data analysis/interpretation: YL, YO, JS, YO, DK, SN, JTH, CP, CPK, ES, and KKZ. Drafting manuscript: YL. YO, JS, JTH, and CP. Supervision: ES and KKZ. Each author contributed important intellectual content during manuscript drafting or revision. Publisher Copyright: {\textcopyright} 2019 American Society for Bone and Mineral Research",
year = "2020",
month = feb,
day = "1",
doi = "10.1002/jbmr.3893",
language = "English",
volume = "35",
pages = "317--325",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "Wiley-Blackwell",
number = "2",
}