PTH variability is associated with increased risk of mortality in Japanese hemodialysis patients.

IF 1.7 4区医学 Q2 UROLOGY & NEPHROLOGY

Clinical and Experimental Nephrology Pub Date : 2025-10-07 DOI:10.1007/s10157-025-02777-7

Tadashi Kato, Kiryu Yoshida, Maki Abe, Mayu Yamashita, Kazuki Kobayashi, Tomohiro Saito, Toshiaki Takezaki, Noriyuki Kato, Masahide Mizobuchi, Fumihiko Koiwa, Hiroaki Ogata, Hirokazu Honda

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引用次数: 0

Abstract

Background: Elevated parathyroid hormone (PTH) levels are associated with cardiovascular events, bone disease, and mortality in patients undergoing maintenance hemodialysis. Although PTH levels vary widely in patients undergoing hemodialysis, whether this affects mortality is unclear.

Methods: A total of 315 maintenance hemodialysis patients who underwent PTH measurements at least twice a year were enrolled. The association between all-cause mortality, cardiovascular events, and fractures was evaluated in patients with PTH concentrations of 60-240 pg/mL (time-in-target range (TTR) 100%) and those with TTR values of 75% ≤ TTR < 100%, 50% ≤ TTR < 75%, and TTR < 50%.

Results: There were 122 patients with TTR 100%, 81 patients with 75% ≤ TTR < 100%, 52 patients with 50% ≤ TTR < 75%, and 74 patients with TTR < 50%. Over the 4-year observation period, patients with TTR of 100% had significantly lower all-cause mortality than those with TTR < 50%. (HR 2.26, 95% CI 1.33-3.86) Subgroup analysis by presence or absence of pharmacological intervention showed no statistically significant difference in all-cause mortality in the treatment group (HR 2.08, 95% CI 1.16-3.72), but showed significant differences in the no-treatment group (HR 1.58, 95% CI 0.92-2.70).

Conclusion: A prolonged period of deviation from the optimal PTH range was associated with increased all-cause mortality, particularly among patients not receiving SHPT medication. However, this effect was not observed in patients who received pharmacological interventions. These results suggest that early intervention is desirable when PTH levels vary from the optimal range in patients with secondary hyperparathyroidism.

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日本血液透析患者PTH变异性与死亡风险增加相关。

背景：在维持性血液透析患者中，甲状旁腺激素（PTH）水平升高与心血管事件、骨病和死亡率相关。尽管接受血液透析的患者甲状旁腺激素水平差异很大，但这是否会影响死亡率尚不清楚。方法：共纳入315例维持性血液透析患者，每年至少进行两次甲状旁腺激素测量。在PTH浓度为60-240 pg/mL（目标时间范围（TTR） 100%）和TTR值为75%≤TTR的患者中，评估了全因死亡率、心血管事件和骨折之间的关系。结果：TTR为100%的患者有122例，75%≤TTR的患者有81例。结论：偏离最佳PTH范围的时间延长与全因死亡率增加有关，特别是在未接受SHPT药物治疗的患者中。然而，在接受药物干预的患者中没有观察到这种效果。这些结果表明，当继发性甲状旁腺功能亢进患者的甲状旁腺激素水平偏离最佳范围时，早期干预是可取的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Nephrology UROLOGY & NEPHROLOGY-

CiteScore

4.10

自引率

4.30%

发文量

135

审稿时长

4-8 weeks

期刊介绍： Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.