Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients

Jessica E. Miller, Csaba Kovesdy, Keith C. Norris, Rajnish Mehrotra, Allen R. Nissenson, Joel D. Kopple, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Background: The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time. Methods: We employed a Cox model using up-to-5-year (7/2001-6/2006) time-averaged values to examine the mortality-predictability of cumulative serum calcium levels in 107,200 hemodialysis patients prior to the use of calcimimetics, but during the time where other calcium-lowering interventions, including lower dialysate calcium, were employed. Results: Both low (<9.0 mg/dl) and high (>10.0 mg/dl) calcium levels were associated with increased mortality (reference: 9.0 to <9.5 mg/dl). Whereas mortality of hypercalcemia was consistent, hypocalcemia mortality was most prominent with higher serum phosphorus (>3.5 mg/dl) and PTH levels (>150 pg/ml). Higher paricalcitol doses shifted the calcium range associated with the greatest survival to the right, i.e. from 9.0 to <9.5 to 9.5 to <10.0 mg/dl. African-Americans exhibited the highest death hazard ratio of hypocalcemia <8.5 mg/dl, being 1.35 (95% CI: 1.22-1.49). Both a rise and drop in serum calcium over 6 months were associated with increased mortality compared to the stable group. Conclusions: Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.

Original languageEnglish (US)
Pages (from-to)403-413
Number of pages11
JournalAmerican Journal of Nephrology
Volume32
Issue number5
DOIs
StatePublished - Nov 1 2010

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Renal Dialysis
Calcium
Mortality
Serum
Hypocalcemia
Dialysis Solutions
Proportional Hazards Models
African Americans
Phosphorus
Survival

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Miller, J. E., Kovesdy, C., Norris, K. C., Mehrotra, R., Nissenson, A. R., Kopple, J. D., & Kalantar-Zadeh, K. (2010). Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients. American Journal of Nephrology, 32(5), 403-413. https://doi.org/10.1159/000319861

Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients. / Miller, Jessica E.; Kovesdy, Csaba; Norris, Keith C.; Mehrotra, Rajnish; Nissenson, Allen R.; Kopple, Joel D.; Kalantar-Zadeh, Kamyar.

In: American Journal of Nephrology, Vol. 32, No. 5, 01.11.2010, p. 403-413.

Research output: Contribution to journalArticle

Miller, JE, Kovesdy, C, Norris, KC, Mehrotra, R, Nissenson, AR, Kopple, JD & Kalantar-Zadeh, K 2010, 'Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients', American Journal of Nephrology, vol. 32, no. 5, pp. 403-413. https://doi.org/10.1159/000319861
Miller, Jessica E. ; Kovesdy, Csaba ; Norris, Keith C. ; Mehrotra, Rajnish ; Nissenson, Allen R. ; Kopple, Joel D. ; Kalantar-Zadeh, Kamyar. / Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients. In: American Journal of Nephrology. 2010 ; Vol. 32, No. 5. pp. 403-413.
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