Impact of age on survival predictability of bone turnover markers in hemodialysis patients

Paungpaga Lertdumrongluk, Wei Ling Lau, Jongha Park, Connie M. Rhee, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

BackgroundAbnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages.MethodsWe examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models.ResultsHigher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥45 years). Compared with patients with serum PTH 150 to <300pg/mL, the death risks were higher in patients with serum PTH 300 to <600pg/mL [HRs (95% CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥75 years, respectively], and ≥600pg/mL [HRs(95% CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years.ConclusionsThere are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels.

Original languageEnglish (US)
Pages (from-to)2535-2545
Number of pages11
JournalNephrology Dialysis Transplantation
Volume28
Issue number10
DOIs
StatePublished - Oct 1 2013

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Bone Remodeling
Renal Dialysis
Parathyroid Hormone
Survival
Alkaline Phosphatase
Serum
Mortality
Proportional Hazards Models
Dialysis
Age Groups
Biomarkers

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

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Impact of age on survival predictability of bone turnover markers in hemodialysis patients. / Lertdumrongluk, Paungpaga; Lau, Wei Ling; Park, Jongha; Rhee, Connie M.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 28, No. 10, 01.10.2013, p. 2535-2545.

Research output: Contribution to journalArticle

Lertdumrongluk, Paungpaga ; Lau, Wei Ling ; Park, Jongha ; Rhee, Connie M. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Impact of age on survival predictability of bone turnover markers in hemodialysis patients. In: Nephrology Dialysis Transplantation. 2013 ; Vol. 28, No. 10. pp. 2535-2545.
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abstract = "BackgroundAbnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages.MethodsWe examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models.ResultsHigher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥45 years). Compared with patients with serum PTH 150 to <300pg/mL, the death risks were higher in patients with serum PTH 300 to <600pg/mL [HRs (95{\%} CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥75 years, respectively], and ≥600pg/mL [HRs(95{\%} CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years.ConclusionsThere are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels.",
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AU - Lertdumrongluk, Paungpaga

AU - Lau, Wei Ling

AU - Park, Jongha

AU - Rhee, Connie M.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

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N2 - BackgroundAbnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages.MethodsWe examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models.ResultsHigher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥45 years). Compared with patients with serum PTH 150 to <300pg/mL, the death risks were higher in patients with serum PTH 300 to <600pg/mL [HRs (95% CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥75 years, respectively], and ≥600pg/mL [HRs(95% CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years.ConclusionsThere are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels.

AB - BackgroundAbnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages.MethodsWe examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models.ResultsHigher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥45 years). Compared with patients with serum PTH 150 to <300pg/mL, the death risks were higher in patients with serum PTH 300 to <600pg/mL [HRs (95% CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥75 years, respectively], and ≥600pg/mL [HRs(95% CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years.ConclusionsThere are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels.

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