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Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease.

Publication ,  Journal Article
Geng, S; Kuang, Z; Peissig, PL; Page, D; Maursetter, L; Hansen, KE
Published in: Osteoporos Int
October 2019

UNLABELLED: Doctors do not know whether treatment of high parathyroid hormone levels is linked to better outcomes in their patients with kidney disease. In this study, lower parathyroid hormone levels at baseline were linked to lower risk of fracture, vascular events, and death in people with kidney disease. PURPOSE: Chronic kidney disease (CKD) affects ~ 20% of older adults, and secondary hyperparathyroidism (HPT) is a common condition in these patients. To what degree HPT predicts fractures, vascular events, and mortality in pre-dialysis CKD patients is debated. In stage 3 and 4 CKD patients, we assessed relationships between baseline serum PTH levels and subsequent 10-year probabilities of clinical fractures, vascular events, and death. METHODS: We used Marshfield Clinic Health System electronic health records to analyze data from adult CKD patients receiving care between 1985 and 2013, and whose PTH was measured using a second-generation assay. Covariates included PTH, age, gender, tobacco use, vascular disease, diabetes, hypertension, hyperlipidemia, obesity, GFR, and use of osteoporosis medications. RESULTS: Five thousand one hundred eight subjects had a mean age of 68 ± 17 years, 48% were men, and mean follow-up was 23 ± 10 years. Fractures, vascular events, and death occurred in 18%, 71%, and 56% of the cohort, respectively. In univariate and multivariate models, PTH was an independent predictor of fracture, vascular events, and death. The hazards of fracture, vascular events and death were minimized at a baseline PTH of 0, 69, and 58 pg/mL, respectively. CONCLUSIONS: We found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.

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Published In

Osteoporos Int

DOI

EISSN

1433-2965

Publication Date

October 2019

Volume

30

Issue

10

Start / End Page

2019 / 2025

Location

England

Related Subject Headings

  • Wisconsin
  • Vascular Diseases
  • Severity of Illness Index
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Parathyroid Hormone
  • Osteoporotic Fractures
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

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Geng, S., Kuang, Z., Peissig, P. L., Page, D., Maursetter, L., & Hansen, K. E. (2019). Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int, 30(10), 2019–2025. https://doi.org/10.1007/s00198-019-05033-3
Geng, S., Z. Kuang, P. L. Peissig, D. Page, L. Maursetter, and K. E. Hansen. “Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease.Osteoporos Int 30, no. 10 (October 2019): 2019–25. https://doi.org/10.1007/s00198-019-05033-3.
Geng S, Kuang Z, Peissig PL, Page D, Maursetter L, Hansen KE. Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int. 2019 Oct;30(10):2019–25.
Geng, S., et al. “Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease.Osteoporos Int, vol. 30, no. 10, Oct. 2019, pp. 2019–25. Pubmed, doi:10.1007/s00198-019-05033-3.
Geng S, Kuang Z, Peissig PL, Page D, Maursetter L, Hansen KE. Parathyroid hormone independently predicts fracture, vascular events, and death in patients with stage 3 and 4 chronic kidney disease. Osteoporos Int. 2019 Oct;30(10):2019–2025.
Journal cover image

Published In

Osteoporos Int

DOI

EISSN

1433-2965

Publication Date

October 2019

Volume

30

Issue

10

Start / End Page

2019 / 2025

Location

England

Related Subject Headings

  • Wisconsin
  • Vascular Diseases
  • Severity of Illness Index
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Parathyroid Hormone
  • Osteoporotic Fractures
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate