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Mineral and bone disorder management in hemodialysis patients : Comparing PTH control practices in Japan with Europe and North America: The Dialysis Outcomes and Practice Patterns Study (DOPPS) 11 Medical and Health Sciences 1103 Clinical Sciences

Yamamoto, Suguru; Karaboyas, Angelo; Komaba, Hirotaka; Taniguchi, Masatomo; Nomura, Takanobu; Bieber, Brian A.; De Sequera, Patricia; Christensson, Anders LU ; Pisoni, Ronald L. and Robinson, Bruce M., et al. (2018) In BMC Nephrology 19(1).
Abstract

Background: High-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality. Methods: We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-5 (2009-2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions... (More)

Background: High-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality. Methods: We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-5 (2009-2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions (Europe/Australia/New Zealand [Eur/ANZ], Japan and North America) and dialysis vintage. Mortality rates were compared across PTH control categories using Cox regression models. Results: Mean PTH was lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage < 90 days, PTH level was more likely to decline > 5% per month in Japan (48% of patients) versus Eur/ANZ (35%) and North America (35%). In patients with dialysis vintage > 1 year, Japanese patients maintained steady PTH, while patients in Eur/ANZ and North America were more likely to experience a PTH increase. Mean PTH was associated with mortality in the overall samples (highest mortality rate for PTH > 600 pg/mL, hazard ratio, 1.35; 95% confidence interval, 1.20 to 1.52 vs PTH 200-399 pg/mL), and the association was obvious in the prevalent patients (hazard ratio, 1.44; 95% confidence interval, 1.26 to 1.65). PTH slope and MSE did not show significant association with mortality in the overall sample as well as in subjects stratified both by region and dialysis vintage. Conclusion: PTH control in hemodialysis patients, as measured by keeping a stable PTH level over 9 months, was observed in Japan contrasted with other regions. High PTH mean, but not increased PTH slope and MSE, was associated with mortality especially in prevalent patients.

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keywords
Dialysis outcomes and practice patterns study, Hemodialysis, Japanese society for Dialysis therapy, Parathyroid hormone, PTH slope
in
BMC Nephrology
volume
19
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85054445392
ISSN
1471-2369
DOI
10.1186/s12882-018-1056-5
language
English
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yes
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e281340b-2717-4aed-8f13-e35ac9416720
date added to LUP
2018-10-30 14:26:18
date last changed
2019-05-21 04:14:05
@article{e281340b-2717-4aed-8f13-e35ac9416720,
  abstract     = {<p>Background: High-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality. Methods: We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-5 (2009-2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions (Europe/Australia/New Zealand [Eur/ANZ], Japan and North America) and dialysis vintage. Mortality rates were compared across PTH control categories using Cox regression models. Results: Mean PTH was lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage &lt; 90 days, PTH level was more likely to decline &gt; 5% per month in Japan (48% of patients) versus Eur/ANZ (35%) and North America (35%). In patients with dialysis vintage &gt; 1 year, Japanese patients maintained steady PTH, while patients in Eur/ANZ and North America were more likely to experience a PTH increase. Mean PTH was associated with mortality in the overall samples (highest mortality rate for PTH &gt; 600 pg/mL, hazard ratio, 1.35; 95% confidence interval, 1.20 to 1.52 vs PTH 200-399 pg/mL), and the association was obvious in the prevalent patients (hazard ratio, 1.44; 95% confidence interval, 1.26 to 1.65). PTH slope and MSE did not show significant association with mortality in the overall sample as well as in subjects stratified both by region and dialysis vintage. Conclusion: PTH control in hemodialysis patients, as measured by keeping a stable PTH level over 9 months, was observed in Japan contrasted with other regions. High PTH mean, but not increased PTH slope and MSE, was associated with mortality especially in prevalent patients.</p>},
  articleno    = {253},
  author       = {Yamamoto, Suguru and Karaboyas, Angelo and Komaba, Hirotaka and Taniguchi, Masatomo and Nomura, Takanobu and Bieber, Brian A. and De Sequera, Patricia and Christensson, Anders and Pisoni, Ronald L. and Robinson, Bruce M. and Fukagawa, Masafumi},
  issn         = {1471-2369},
  keyword      = {Dialysis outcomes and practice patterns study,Hemodialysis,Japanese society for Dialysis therapy,Parathyroid hormone,PTH slope},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Nephrology},
  title        = {Mineral and bone disorder management in hemodialysis patients : Comparing PTH control practices in Japan with Europe and North America: The Dialysis Outcomes and Practice Patterns Study (DOPPS) 11 Medical and Health Sciences 1103 Clinical Sciences},
  url          = {http://dx.doi.org/10.1186/s12882-018-1056-5},
  volume       = {19},
  year         = {2018},
}