Outcomes associated with serum calcium level in men with non-dialysis-dependent chronic kidney disease

Csaba Kovesdy, Olga Kuchmak, Jun L. Lu, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background and objectives: Elevated serum calcium has been associated with increased mortality in dialysis patients, but it is unclear whether the same is true in non-dialysis-dependent (NDD) chronic kidney disease (CKD). Outcomes associated with low serum calcium are also not well-characterized. Design, setting, participants, & measurements: We examined associations of baseline, time-varying, and time-averaged serum calcium with all-cause mortality in a historic prospective cohort of 1243 men with moderate and advanced NDD CKD by using Cox models. Results: The association of serum calcium with mortality varied according to the applied statistical models. Higher baseline calcium and time-averaged calcium were associated with higher mortality (multivariable adjusted hazard ratio (95% confidence interval): 1.31 (1.13, 1.53); P < 0.001 for a baseline calcium 1 mg/dl higher). However, in time-varying analyses, lower calcium levels were associated with increased mortality. Conclusions: Higher serum calcium is associated with increased long-term mortality (as reflected by the baseline and time-averaged models), and lower serum calcium is associated with increased short-term mortality (as reflected by the time-varying models) in patients with NDD CKD. Clinical trials are warranted to determine whether maintaining normal serum calcium can improve outcomes in these patients.

Original languageEnglish (US)
Pages (from-to)468-476
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume5
Issue number3
DOIs
StatePublished - Mar 1 2010

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Chronic Renal Insufficiency
Calcium
Serum
Mortality
Statistical Models
Proportional Hazards Models
Dialysis
Clinical Trials
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Outcomes associated with serum calcium level in men with non-dialysis-dependent chronic kidney disease. / Kovesdy, Csaba; Kuchmak, Olga; Lu, Jun L.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 5, No. 3, 01.03.2010, p. 468-476.

Research output: Contribution to journalArticle

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N2 - Background and objectives: Elevated serum calcium has been associated with increased mortality in dialysis patients, but it is unclear whether the same is true in non-dialysis-dependent (NDD) chronic kidney disease (CKD). Outcomes associated with low serum calcium are also not well-characterized. Design, setting, participants, & measurements: We examined associations of baseline, time-varying, and time-averaged serum calcium with all-cause mortality in a historic prospective cohort of 1243 men with moderate and advanced NDD CKD by using Cox models. Results: The association of serum calcium with mortality varied according to the applied statistical models. Higher baseline calcium and time-averaged calcium were associated with higher mortality (multivariable adjusted hazard ratio (95% confidence interval): 1.31 (1.13, 1.53); P < 0.001 for a baseline calcium 1 mg/dl higher). However, in time-varying analyses, lower calcium levels were associated with increased mortality. Conclusions: Higher serum calcium is associated with increased long-term mortality (as reflected by the baseline and time-averaged models), and lower serum calcium is associated with increased short-term mortality (as reflected by the time-varying models) in patients with NDD CKD. Clinical trials are warranted to determine whether maintaining normal serum calcium can improve outcomes in these patients.

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