Nephro-Urology Monthly

Published by: Kowsar

Serum Levels of Intact Parathyroid Hormone, Calcium, and Phosphorus and Risk of Mortality in Hemodialysis Patients

Tayebeh Soleymanian 1 , * , Neda Nikzad 2 , Alireza Mahjoub 2 , Hassan Argani 3 and Shokoofe Saavaj 4
Authors Information
1 Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
2 Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, International Branch, Tehran, IR Iran
3 Urology and Nephrology Research Center, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
4 Firouzgar Hospital, Iran University of Medical Sciences, Tehran, IR Iran
Article information
  • Nephro-Urology Monthly: January 01, 2017, 9 (1); e42569
  • Published Online: December 24, 2016
  • Article Type: Research Article
  • Received: September 30, 2016
  • Revised: November 5, 2016
  • Accepted: December 14, 2016
  • DOI: 10.5812/numonthly.42569

To Cite: Soleymanian T, Nikzad N, Mahjoub A, Argani H, Saavaj S. Serum Levels of Intact Parathyroid Hormone, Calcium, and Phosphorus and Risk of Mortality in Hemodialysis Patients, Nephro-Urol Mon. 2017 ; 9(1):e42569. doi: 10.5812/numonthly.42569.

Copyright © 2016, Nephrology and Urology Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Methods
3. Results
4. Discussion
  • 1. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8): 2208-18[DOI][PubMed]
  • 2. Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005; 67(3): 1179-87[DOI][PubMed]
  • 3. Kalantar-Zadeh K, Kuwae N, Regidor DL, Kovesdy CP, Kilpatrick RD, Shinaberger CS, et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int. 2006; 70(4): 771-80[DOI][PubMed]
  • 4. Wald R, Sarnak MJ, Tighiouart H, Cheung AK, Levey AS, Eknoyan G, et al. Disordered mineral metabolism in hemodialysis patients: an analysis of cumulative effects in the Hemodialysis (HEMO) Study. Am J Kidney Dis. 2008; 52(3): 531-40[DOI][PubMed]
  • 5. Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008; 52(3): 519-30[DOI][PubMed]
  • 6. Melamed ML, Eustace JA, Plantinga L, Jaar BG, Fink NE, Coresh J, et al. Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study. Kidney Int. 2006; 70(2): 351-7[DOI][PubMed]
  • 7. Danese MD, Belozeroff V, Smirnakis K, Rothman KJ. Consistent control of mineral and bone disorder in incident hemodialysis patients. Clin J Am Soc Nephrol. 2008; 3(5): 1423-9[DOI][PubMed]
  • 8. Floege J, Kim J, Ireland E, Chazot C, Drueke T, de Francisco A, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant. 2011; 26(6): 1948-55[DOI][PubMed]
  • 9. Rostami Z, Hosseini MS, Lessan Pezeshki M, Heidari F, Einollahi B. Bone mineral metabolism and subsequent hospitalization with poor quality of life in dialysis patients. Nephrourol Mon. 2014; 6(1)[DOI][PubMed]
  • 10. Block GA. Therapeutic interventions for chronic kidney disease-mineral and bone disorders: focus on mortality. Curr Opin Nephrol Hypertens. 2011; 20(4): 376-81[DOI][PubMed]
  • 11. Block GA, Kilpatrick RD, Lowe KA, Wang W, Danese MD. CKD-mineral and bone disorder and risk of death and cardiovascular hospitalization in patients on hemodialysis. Clin J Am Soc Nephrol. 2013; 8(12): 2132-40[DOI][PubMed]
  • 12. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000; 342(20): 1478-83[DOI][PubMed]
  • 13. Streja E, Wang HY, Lau WL, Molnar MZ, Kovesdy CP, Kalantar-Zadeh K, et al. Mortality of combined serum phosphorus and parathyroid hormone concentrations and their changes over time in hemodialysis patients. Bone. 2014; 61: 201-7[DOI][PubMed]
  • 14. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med. 2000; 108(8): 609-13[PubMed]
  • 15. Rattanasompattikul M, Feroze U, Molnar MZ, Dukkipati R, Kovesdy CP, Nissenson AR, et al. Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients. Int Urol Nephrol. 2012; 44(6): 1813-23[DOI][PubMed]
  • 16. Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel DM. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int. 2007; 71(5): 438-41[DOI][PubMed]
  • 17. Wang AY, Wang M, Woo J, Lam CW, Li PK, Lui SF, et al. Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol. 2003; 14(1): 159-68[PubMed]
  • 18. Danese MD, Halperin M, Lowe KA, Bradbury BD, Do TP, Block GA. Refining the definition of clinically important mineral and bone disorder in hemodialysis patients. Nephrol Dial Transplant. 2015; 30(8): 1336-44[DOI][PubMed]
  • 19. Guideline Working Group JSFDT. Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial. 2008; 12(6): 514-25[DOI][PubMed]
  • 20. Nakai S, Masakane I, Shigematsu T, Hamano T, Yamagata K, Watanabe Y, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2007). Ther Apher Dial. 2009; 13(6): 457-504[DOI][PubMed]
  • 21. Nakai S, Akiba T, Kazama J, Yokoyama K, Fukagawa M, Tominaga Y, et al. Effects of serum calcium, phosphorous, and intact parathyroid hormone levels on survival in chronic hemodialysis patients in Japan. Ther Apher Dial. 2008; 12(1): 49-54[DOI][PubMed]
  • 22. Dukkipati R, Kovesdy CP, Colman S, Budoff MJ, Nissenson AR, Sprague SM, et al. Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients. J Ren Nutr. 2010; 20(4): 243-54[DOI][PubMed]
  • 23. Kalantar-Zadeh K, Kopple JD. Response to ‘Adynamic Bone Disease and MICS’. Kidney Int. 2007; 71(12): 1327
  • 24. Fukagawa M, Akizawa T, Kurokawa K. Is aplastic osteodystrophy a disease of malnutrition? Curr Opin Nephrol Hypertens. 2000; 9(4): 363-7[PubMed]
  • 25. Recent Advances in Understanding the Malnutrition‐Inflammation‐Cachexia Syndrome in Chronic Kidney Disease Patients: What is Next? Seminars in dialysis. : 365-9
  • 26. Amanzadeh J, Reilly RJ. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol. 2006; 2(3): 136-48[DOI][PubMed]
  • 27. Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr. 2004; 80(2): 299-307[PubMed]
  • 28. Shinaberger CS, Kilpatrick RD, Regidor DL, McAllister CJ, Greenland S, Kopple JD, et al. Longitudinal associations between dietary protein intake and survival in hemodialysis patients. Am J Kidney Dis. 2006; 48(1): 37-49[DOI][PubMed]
  • 29. Qi Q, Monier-Faugere MC, Geng Z, Malluche HH. Predictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis. Am J Kidney Dis. 1995; 26(4): 622-31[PubMed]
  • 30. Kalantar-Zadeh K, Shah A, Duong U, Hechter RC, Dukkipati R, Kovesdy CP. Kidney bone disease and mortality in CKD: revisiting the role of vitamin D, calcimimetics, alkaline phosphatase, and minerals. Kidney Int Suppl. 2010; (117)-21[DOI][PubMed]
  • 31. Carlstedt E, Ridefelt P, Lind L, Rastad J. Interleukin-6 induced suppression of bovine parathyroid hormone secretion. Biosci Rep. 1999; 19(1): 35-42[PubMed]
  • 32. Nielsen PK, Rasmussen AK, Butters R, Feldt-Rasmussen U, Bendtzen K, Diaz R, et al. Inhibition of PTH secretion by interleukin-1 beta in bovine parathyroid glands in vitro is associated with an up-regulation of the calcium-sensing receptor mRNA. Biochem Biophys Res Commun. 1997; 238(3): 880-5[DOI][PubMed]
  • 33. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001; 12(10): 2131-8[PubMed]
  • 34. Kalantar-Zadeh K, Miller JE, Kovesdy CP, Mehrotra R, Lukowsky LR, Streja E, et al. Impact of race on hyperparathyroidism, mineral disarrays, administered vitamin D mimetic, and survival in hemodialysis patients. J Bone Miner Res. 2010; 25(12): 2724-34[DOI][PubMed]
  • 35. Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA. 2011; 305(11): 1119-27[DOI][PubMed]
  • 36. Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, et al. Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2006; 70(7): 1358-66[DOI][PubMed]
  • 37. Danese MD, Kim J, Doan QV, Dylan M, Griffiths R, Chertow GM. PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis. 2006; 47(1): 149-56[DOI][PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments