This article is more than 5 years old. Information may no longer be current.
Levels of mineral and bone disorder markers vary among race and country
Click Here to Manage Email Alerts
Researchers found differences for levels of parathyroid hormone, calcium and phosphorus in the first 5 years of hemodialysis based on patient race and country of origin.
“The average life expectancy of a U.S. dialysis patient after initiating dialysis is almost 5 years. Although there are mineral and bone disorder studies that compare calcium, phosphorus and parathyroid hormone level management in a limited cohort of dialysis patients, few studies provide longitudinal data for mineral and bone disorder practice patterns and how these biochemical factors change in the period after dialysis initiation and during the lifetime of a dialysis patient in relation to race, geography, and drug treatment,” Kevin Chan, MD, in the division of nephrology at Massachusetts General Hospital in Boston, and colleagues wrote.
The prospective cohort study followed patients on hemodialysis from nine countries including the United States, Japan, Italy and Belgium. Patients were assessed during phases 4 and 5 of the study from 2009 to 2015. The results yielded a total of 33,517 patients which included 7,123 U.S. black/African Americans, 14,642 U.S. non-black/African Americans, 2,745 patients from Japan and 9,007 patients from Europe. In their primary analysis, the researchers used locally weighted regression to model mean values of parathyroid hormone, serum phosphorus and calcium in the monthly cross-sections by dialysis vintage. For secondary analyses, the distributions of mineral and bone disorder laboratory values and prescription prevalence were reported at two cross-sections: the first month and the 36th month after initiating hemodialysis therapy.
Data showed mean parathyroid hormone decline during the first 4 months of hemodialysis across all of the groups. However, it increased continuously during the next 4.5 years for the U.S. and European patients. By month 36, the mean calcium level was lower in patients from Japan (8.8 mg/dL) in comparison to U.S. patients (9 mg/dL to 9.1 mg/dL). The mean phosphorus level was lower in patients from Europe (4.8 mg/dL) than for patients from the United States and Japan (5.1 mg/dL to 5.3 mg/dL). Also, during month 36, U.S. black/African Americans experienced the highest mean parathyroid hormone level (496 pg/ml) regardless of being prescribed a greater dosage of cinacalcet (23%) and active vitamin D (85%).
“Future study is warranted to explore other potential contributors to international and racial differences in parathyroid hormone levels and how they may affect therapeutic approaches to improve parathyroid hormone management and ultimately minimize consequent bone and cardiovascular complications,” Chan and colleagues wrote. – by Alexandria Brooks
Disclosures: Chan reports he has acted as a consultant to Relypsa Inc. Please see the full study for all other authors’ relevant financial disclosures.