Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Subject Collections
    • JASN Podcasts
    • Archives
    • Saved Searches
    • ASN Meeting Abstracts
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Editorial Team
  • Subscriptions
  • More
    • About JASN
    • Alerts
    • Advertising
    • Editorial Fellowship Program
    • Feedback
    • Reprints
    • Impact Factor
  • ASN Kidney News
  • Other
    • CJASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • CJASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Subject Collections
    • JASN Podcasts
    • Archives
    • Saved Searches
    • ASN Meeting Abstracts
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Editorial Team
  • Subscriptions
  • More
    • About JASN
    • Alerts
    • Advertising
    • Editorial Fellowship Program
    • Feedback
    • Reprints
    • Impact Factor
  • ASN Kidney News
  • Follow JASN on Twitter
  • Visit ASN on Facebook
  • Follow JASN on RSS
  • Community Forum
Human Mineral Metabolism and Bone Disease
You have accessRestricted Access

Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis

Geoffrey A. Block, Preston S. Klassen, J. Michael Lazarus, Norma Ofsthun, Edmund G. Lowrie and Glenn M. Chertow
JASN August 2004, 15 (8) 2208-2218; DOI: https://doi.org/10.1097/01.ASN.0000133041.27682.A2
Geoffrey A. Block
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Preston S. Klassen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
J. Michael Lazarus
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Norma Ofsthun
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Edmund G. Lowrie
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Glenn M. Chertow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Figure1
    • Download figure
    • Open in new tab
    • Download powerpoint

    Figure 1. Unadjusted, case mix–adjusted, and multivariable-adjusted relative risks (RR; of death) and 95% confidence intervals (CI) for eight categories of serum phosphorus (referent range, 4.0 to 5.0 mg/dl). For all analyses, case mix adjustment refers to adjustment for age, gender, race or ethnicity, diabetes, and vintage. Multivariable adjustment refers to case mix plus body weight, URR*, serum albumin, creatinine, predialysis BUN*, bicarbonate*, cholesterol, hemoglobin, ferritin*, and aluminum. Phosphorus models simultaneously adjusted for calcium + parathyroid hormone (PTH), calcium models simultaneously adjusted for phosphorus + PTH, PTH models simultaneously adjusted for phosphorus + calcium. *Inclusion of linear and quadratic terms. Categories of vintage <2 yr (referent), 2 to 5 yr, ≥5 yr, and missing. Categories of cholesterol <120, 120 to 160, 160 to 200 (referent), 200 to 240, ≥240 mg/dl, and missing. Companion models substituting body surface area, Quetèlet’s index, or calculated total body water for body weight, and Kt/V or Kt for URR did not change parameter estimates for phosphorus, calcium, or PTH.

  • Figure2
    • Download figure
    • Open in new tab
    • Download powerpoint

    Figure 2. Unadjusted, case mix–adjusted, and multivariable-adjusted RR (of death) and 95% CI for eight categories of measured serum calcium (referent range, 9.0 to 9.5 mg/dl).

  • Figure3
    • Download figure
    • Open in new tab
    • Download powerpoint

    Figure 3. Unadjusted, case mix–adjusted, and multivariable-adjusted RR (of death) and 95% CI for eight categories of adjusted serum calcium (measured calcium adjusted for serum albumin, referent range, 9.0 to 9.5 mg/dl).

  • Figure4
    • Download figure
    • Open in new tab
    • Download powerpoint

    Figure 4. Unadjusted, case mix–adjusted, and multivariable-adjusted RR (of death) and 95% CI for 12 categories of calcium × phosphorus product (referent range, 40 to 45 mg2/dl2).

  • Figure5
    • Download figure
    • Open in new tab
    • Download powerpoint

    Figure 5. Unadjusted, case mix–adjusted, and multivariable-adjusted RR (of death) and 95% CI for four categories of intact parathyroid hormone (referent range, 150 to 300 pg/ml).

Tables

  • Figures
  • Table 1. Patient characteristics by serum phosphorus categorya

    <3 mg/dl (n = 895)3–4 mg/dl (n = 3860)4–5 mg/dl (n = 8723)5–6 mg/dl (n = 10,421)6–7 mg/dl (n = 8367)7–8 mg/dl (n = 4547)8–9 mg/dl (n = 2219)≥9 mg/dl (n = 1506)P Value
    a Values are means; medians presented for vintage and ferritin. P values for proportions and means are age-adjusted. BUN, blood urea nitrogen; URR, urea reduction ratio.
    Age (years)67.366.464.661.958.655.352.148.7<0.0001
    Gender (% female)53%48%50%50%48%48%46%42%<0.0001
    Race/ethnicity (%)<0.0001
        white27%37%39%39%35%35%37%44%
        black56%45%42%41%44%44%43%36%
        Hispanic14%15%15%16%17%18%17%16%
        other3%3%4%3%4%4%4%3%
    Diabetes (%)46%48%50%49%46%43%40%35%<0.0001
    Vintage (years)1.501.461.511.591.821.952.122.07<0.0001
    Weight (kg)65.568.870.672.173.974.975.374.8<0.0001
    Quetèlet’s (body mass) index (kg/m2)25.125.726.226.727.227.427.827.0<0.0001
    Bicarbonate (mEq/L)23.322.621.921.220.619.919.218.1<0.0001
    BUN (mg/dl)4751555862656872<0.0001
    Creatinine (mg/dl)7.78.08.59.310.311.011.612.2<0.0001
    Albumin (g/dl)3.603.743.823.863.903.913.923.93<0.0001
    Cholesterol (mg/dl)1631701721731721701671650.05
    Hemoglobin (g/dl)10.110.310.510.510.510.410.410.30.002
    Ferritin (μg/L)476433431411418408383342<0.0001
    URR (%)69.8%69.5%69.4%68.9%68.4%67.7%67.1%65.9%<0.0001
  • Table 2. Patient characteristics by serum calcium categorya

    <8.0 mg/dl (n = 2325)8.0–8.5 mg/dl (n = 4594)8.5–9.0 mg/dl (n = 10,451)9.0–9.5 mg/dl (n = 10,759)9.5–10.0 mg/dl (n = 6712)10.0–10.5 mg/dl (n = 3652)10.5–11.0 mg/dl (n = 1478)≥11.0 mg/dl (n = 567)P Value
    a Values are means, medians presented for vintage and ferritin. P values for proportions and means are age-adjusted.
    Age (years)52.358.460.561.662.161.961.262.3<0.0001
    Gender (% female)39%41%46%50%53%56%54%60%<0.0001
    Race/ethnicity (%)<0.0001
        white23%31%37%40%40%43%41%41%
        black53%44%43%42%42%40%41%37%
        Hispanic20%21%17%15%13%13%13%18%
        other4%4%3%3%4%4%5%4%
    Diabetes (%)39%49%50%48%44%41%38%40%<0.0001
    Vintage (years)2.51.92.02.42.52.52.52.5<0.0001
    Weight (kg)75.473.572.572.471.670.569.669.9<0.0001
    Quetèlet’s (body mass) index (kg/m2)27.326.926.726.826.526.125.925.9<0.0001
    Bicarbonate (mEq/L)19.020.020.721.221.621.922.422.5<0.0001
    BUN (mg/dl)6661595859585755<0.0001
    Creatinine (mg/dl)11.49.99.39.39.79.79.89.1<0.0001
    Albumin (g/dl)3.963.923.863.833.843.843.793.66<0.0001
    Cholesterol (mg/dl)165169171172172172170171<0.0001
    Hemoglobin (g/dl)10.310.410.410.510.510.510.510.3<0.0001
    Ferritin (μg/L)349367415415445455484488<0.0001
    URR (%)66.2%67.5%68.2%68.9%69.6%69.8%69.6%70.0%<0.0001
  • Table 3. Twenty most common primary ICD-9-CM codesa

    Diagnosis CodeDescriptionN% of First Hospitalizations
    a ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification.
    996.1Mechanical complication of other (noncardiac) vascular device, implant, and graft24239.8%
    585Chronic renal failure21328.6%
    996.70, 73, and 74Other complications of internal prosthetic device, implant, and graft14015.6%
    480–486Pneumonia10864.4%
    276.6Fluid overload8243.3%
    428Congestive heart failure8153.3%
    786.5Chest pain7523.0%
    038.9Unspecified septicemia6302.5%
    578Gastrointestinal hemorrhage3561.4%
    999.9Other and unspecified complications of medical care2711.1%
    681–682Cellulitis and abscess2581.0%
    443Peripheral vascular disease2391.0%
    427.5Cardiac arrest2310.9%
    996.62Infection and inflammatory reaction as a result of other (noncardiac) vascular device, implant, and graft2280.9%
    787.01Nausea with vomiting2050.8%
    410Acute myocardial infarction1980.8%
    413Angina pectoris1710.7%
    780.6Fever1560.6%
    785.4Gangrene1280.5%
    251.2Hypoglycemia1030.4%
PreviousNext
Back to top

In this issue

Journal of the American Society of Nephrology: 15 (8)
Journal of the American Society of Nephrology
Vol. 15, Issue 8
1 Aug 2004
  • Table of Contents
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in JASN.
Enter multiple addresses on separate lines or separate them with commas.
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
Geoffrey A. Block, Preston S. Klassen, J. Michael Lazarus, Norma Ofsthun, Edmund G. Lowrie, Glenn M. Chertow
JASN Aug 2004, 15 (8) 2208-2218; DOI: 10.1097/01.ASN.0000133041.27682.A2

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
Geoffrey A. Block, Preston S. Klassen, J. Michael Lazarus, Norma Ofsthun, Edmund G. Lowrie, Glenn M. Chertow
JASN Aug 2004, 15 (8) 2208-2218; DOI: 10.1097/01.ASN.0000133041.27682.A2
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Materials and Methods
    • Results
    • Discussion
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

  • Reduced Plasma Pyrophosphate Levels in Hemodialysis Patients
  • Sevelamer Controls Parathyroid Hormone–Induced Bone Disease as Efficiently as Calcium Carbonate without Increasing Serum Calcium Levels during Therapy with Active Vitamin D Sterols
  • Increased Osteoblastic Activity and Expression of Receptor Activator of NF-κB Ligand in Nonuremic Nephrotic Syndrome
Show more Human Mineral Metabolism and Bone Disease

Cited By...

  • A Randomized Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD)
  • Parathyroid Hormone Serum Levels and Mortality among Hemodialysis Patients in the Gulf Cooperation Council Countries: Results from the DOPPS (2012-2018)
  • Mortality and Recovery Associated with Kidney Failure due to Acute Kidney Injury
  • Targeting Vascular Calcification in Chronic Kidney Disease
  • Serum Phosphate and Microvascular Function in a Population-Based Cohort
  • Microvasculopathy, Luminal Calcification and Premature Aging in Fetuin-A Deficient Mice
  • Lack of Awareness of Dietary Sources of Phosphorus Is a Clinical Concern
  • Phosphorus binders: The new and the old, and how to choose
  • Parathyroidectomy in the Management of Secondary Hyperparathyroidism
  • Anion Gap as a Determinant of Ionized Fraction of Divalent Cations in Hemodialysis Patients
  • A Pilot Study of OkKidney, a Phosphate Counting Application in Patients on Peritoneal Dialysis
  • Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders
  • Impact of nutritional index on the association between phosphorus concentrations and mortality in haemodialysis patients: a cohort study from dialysis outcomes and practice pattern study in Japan
  • Association of Parameters of Mineral Bone Disorder with Mortality in Patients on Hemodialysis according to Level of Residual Kidney Function
  • Two phosphAte taRGets in End-stage renal disease Trial (TARGET): A Randomized Controlled Trial
  • Effect of Tenapanor on Serum Phosphate in Patients Receiving Hemodialysis
  • Fibroblast growth factor 23 as novel biomarker for early risk stratification after ST-elevation myocardial infarction
  • Association of Serum Phosphorus Concentration with Mortality and Graft Failure among Kidney Transplant Recipients
  • Trajectories of CKD-MBD biochemical parameters over a 2-year period following diagnosis of secondary hyperparathyroidism: a pharmacoepidemiological study
  • Blood Calcification Propensity, Cardiovascular Events, and Survival in Patients Receiving Hemodialysis in the EVOLVE Trial
  • Association Between Serum Phosphate Levels and Stroke Risk in Patients Undergoing Hemodialysis: The Q-Cohort Study
  • Inorganic Phosphate Activates the AKT/mTORC1 Pathway and Shortens the Life Span of an {alpha}-Klotho-Deficient Model
  • Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States
  • Intracellular Phosphate Dynamics in Muscle Measured by Magnetic Resonance Spectroscopy during Hemodialysis
  • Phosphate Toxicity in CKD: The Killer among Us
  • Bone Parameters and Risk of Hip and Femur Fractures in Patients on Hemodialysis
  • Serum PTH reference values established by an automated third-generation assay in vitamin D-replete subjects with normal renal function: consequences of diagnosing primary hyperparathyroidism and the classification of dialysis patients
  • Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism
  • Low Vitamin D and High Fibroblast Growth Factor 23 Serum Levels Associate with Infectious and Cardiac Deaths in the HEMO Study
  • Mineral (Mal)Adaptation to Kidney Disease--Young Investigator Award Address: American Society of Nephrology Kidney Week 2014
  • Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis
  • Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis: The EVOLVE Trial
  • Has Dialysis Payment Reform Led to Initial Racial Disparities in Anemia and Mineral Metabolism Management?
  • Recent Changes in Therapeutic Approaches and Association with Outcomes among Patients with Secondary Hyperparathyroidism on Chronic Hemodialysis: The DOPPS Study
  • Telomeric G-Tail Length and Hospitalization for Cardiovascular Events in Hemodialysis Patients
  • Effects of Cinacalcet on Atherosclerotic and Nonatherosclerotic Cardiovascular Events in Patients Receiving Hemodialysis: The EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) Trial
  • Comparative Mortality-Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis
  • A Randomized Multicenter Trial of Paricalcitol versus Calcitriol for Secondary Hyperparathyroidism in Stages 3-4 CKD
  • Plasma-Parathyroid Hormone Is Associated With Subclinical and Clinical Atherosclerotic Disease in 2 Community-Based Cohorts
  • Calcium Balance and Negative Impact of Calcium Load in Peritoneal Dialysis Patients
  • Ischemic Outcomes After Coronary Intervention of Calcified Vessels in Acute Coronary Syndromes: Pooled Analysis From the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trials
  • What Can We Learn from the Saga of Chitosan Gums in Hyperphosphatemia Therapy?
  • Association of serum alkaline phosphatase with mortality in non-selected European patients with CKD5D: an observational, three-centre survival analysis
  • Increasing Dietary Phosphorus Intake from Food Additives: Potential for Negative Impact on Bone Health
  • Phosphorus and the Kidney: What Is Known and What Is Needed
  • CKD-Mineral and Bone Disorder and Risk of Death and Cardiovascular Hospitalization in Patients on Hemodialysis
  • Evidence-Based Cardiology in Hemodialysis Patients
  • The Connection between Dietary Phosphorus, Cardiovascular Disease, and Mortality: Where We Stand and What We Need to Know
  • Single FGF-23 Measurement and Time-Averaged Plasma Phosphate Levels in Hemodialysis Patients
  • Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD
  • Pharmacology of AMG 416 (Velcalcetide), a Novel Peptide Agonist of the Calcium-Sensing Receptor, for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients
  • 24-Hour Urine Phosphorus Excretion and Mortality and Cardiovascular Events
  • Serum FGF23 and Risk of Cardiovascular Events in Relation to Mineral Metabolism and Cardiovascular Pathology
  • Mechanistic Insights into Vascular Calcification in CKD
  • Association of Pre-Kidney Transplant Markers of Mineral and Bone Disorder with Post-Transplant Outcomes
  • Prescription Patterns and Mineral Metabolism Abnormalities in the Cinacalcet Era: Results from the MBD-5D Study
  • Normal and Pathologic Concentrations of Uremic Toxins
  • Effects of Frequent Hemodialysis on Measures of CKD Mineral and Bone Disorder
  • Racial Differences in Markers of Mineral Metabolism in Advanced Chronic Kidney Disease
  • Google Scholar

Similar Articles

Related Articles

  • This Month’s Highlights
  • PubMed
  • Google Scholar

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Annual Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Author Resources
  • Editorial Fellowship Program
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • JASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About JASN
  • JASN Email Alerts
  • JASN Key Impact Information
  • JASN Podcasts
  • JASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe

© 2021 American Society of Nephrology

Print ISSN - 1046-6673 Online ISSN - 1533-3450

Powered by HighWire