A decrease in intact parathyroid hormone (iPTH) levels is associated with higher mortality in prevalent hemodialysis patients

作者：Villa Bellosta Ricardo^*; Rodriguez Osorio Laura; Mas Sebastian; Abadi Younes; Rubert Mercedes; de la Piedra Concepcion; Gracia Iguacel Carolina; Mahillo Ignacio; Ortiz Alberto; Egido Jesus; Gonzalez Parra Emilio^*

来源：PLos One, 2017, 12(3): e0173831.

DOI：10.1371/journal.pone.0173831

Background
The mortality of dialysis patients is 10- to 100-fold higher than in the general population. Baseline serum PTH levels, and more recently, changes in serum PTH levels (Delta PTH) over time, have been associated to mortality in dialysis patients.
Methods
We explored the relationship between.PTH over 1 year with mortality over the next year in a prospective cohort of 115 prevalent hemodialysis patients from a single center that had median baseline iPTH levels within guideline recommendations.
Results
Median baseline iPTH levels were 205 (116.5, 400) pg/ml. Delta iPTH between baseline and 1 year was 85.2 +/- 57.1 pg/ml. During the second year of follow-up, 27 patients died. Delta iPTH was significantly higher in patients who survived (+ 157.30 +/- 25.82 pg/ml) than in those who died (+39.03 +/- 60.95 pg/ml), while baseline iPTH values were not significantly different. The highest mortality (48%) was observed in patients with a decrease in Delta iPTH (Delta iPTH quartile 1, negative Delta iPTH) and the lowest (12%) mortality in quartile 3 Delta iPTH (Delta iPTH increase 101-300 pg/ml). In a logistic regression model,Delta iPTH was associated with mortality with an odds ratio (OR) of 0.998 (95% CI 0.996-0999, p = 0.038). In multivariable analysis, mortality risk was 73% and 88% lower for patients with Delta iPTH 0-100 pg/ml and 101-300 pg/ml, respectively, than for those with a decrease in Delta iPTH. In patients with a decrease in Delta iPTH, the OR for death was 4.131 (1.515-11.27)(p = 0.006).
Conclusions
In prevalent hemodialysis patients with median baseline iPTH values within the guideline recommended range, a decrease in Delta iPTH was associated with higher mortality. Further studies are required to understand the mechanisms and therapeutic implications of this observation that challenges current clinical practice.

• 出版日期2017-3-24