Impact of calcium, phosphate, PTH abnormalities and management on mortality in hemodialysis: Results from the RISC AVID study

Panichi, Vincenzo
Bigazzi, Roberto
Paoletti, Sabrina
Mantuano, Emanuela
Beati, Sara
Marchetti, Valentina
Bernabini, Giada
Grazi, Giovanni
Giusti, Riccardo
Rosati, Alberto
Migliori, Massimiliano
Betti, Giancarlo
Pasquariello, Antonio
Panicucci, Erica
Barsotti, Giuliano
Bellasi, Antonio

^*Members of the RISCAVID Study Group are listed in the Appendix
¹Nephrology and Dialysis, Versilia Hospital, Lido di Camaiore - Italy
²Nephrology and Dialysis, Livorno Hospital, Livorno - Italy
³Internal Medicine, Pontedera Hospital, Pontedera - Italy
⁴Nephrology and Dialysis, Lucca Hospital, Lucca - Italy
⁶Nephrology and Dialysis, Pisa Hospital, Pisa - Italy
⁷Biomedicine and Statistics, University of Pisa, Pisa - Italy
⁸Internal Medicine Department, University of Pisa, Pisa - Italy
⁹Nephrology, Dialysis and Hypertension Department, S. Orsola-Malpighi Polyclinic, University Hospital, Bologna - Italy

Institutional Review Board (IRB)/Ethics Committee approval was obtained. This paper is in adherence with the Declaration of Helsinki.

The study was registered in the Cochrane Renal Group registry for “Cardiovascular risk in dialysis: RISCAVID study” (#CRG040700112).

Financial support: None declared.

Conflict of interest statement: AB was employed by Genzyme S.r.l, Modena, Italy.

Address for correspondence:

Vincenzo Panichi, MD

Nephrology and Dialysis

Versilia Hospital

Via Aurelia, 335

Lido di Camaiore, Lucca, Italy

[email protected]

Received: March 26, 2009

Revised: October 14, 2009

Accepted: October 20, 2009

Journal of Nephrology 23(5):p 556-562, September-October 2010.

Abstract

Background:

Despite substantial progress in medical care, the mortality rate remains unacceptably high in dialysis patients. Evidence suggests that bone mineral dismetabolism (CKD-MBD) might contribute to this burden of death. However, to date only a few papers have investigated the clinical relevance of serum mineral derangements and the impact of different therapeutic strategies on mortality in a homogeneous cohort of south European dialysis patients.

Methods:

The RISCAVID study was a prospective, observational study in which all patients receiving hemodialysis (HD) in the north-western region of Toscany in June 2004 were enrolled (N=757) and followed up for 24 months.

Results:

At study entry, only 71 (9%) patients of the entire study cohort exhibited an optimal control of serum phosphorous (Pi), calcium (Ca), calciumXphosphorous product (CAXPi) and intact parathyroidhormone (iPTH) according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical guidelines. Despite a similar prevalence, the severity of CKD-MBD appeared different to the results reported in the USA. Interestingly, none of the serum biomarkers or number of serum biomarkers within KDOQI targets was independently associated with all-cause and cardiovascular (CV) mortality. Among treatments, Sevelamer was the only drug independently associated with lower all-cause and cardiovascular mortality (p<0.001).

Conclusion:

The RISCAVID study highlights the difficulty of controlling bone mineral metabolism in HD patients and lends support to the hypothesis that a carefully chosen phosphate binder might impact survival in HD patients.