ENROLLMENT PARATHYROID-HORMONE LEVEL IS A NEW MARKER OF SURVIVAL IN HEMODIALYSIS AND PERITONEAL-DIALYSIS THERAPY FOR UREMIA

The relatively high morbidity and mortality during dialytic therapy fo r end-stage renal disease (ESRD) in the United States is the subject o f current inquiry, Identified risk factors for excess mortality includ e advanced age, diabetes, and malnutrition exemplified by a low serum albumin level, Parathyroid hormone (PTH) has long been thought to cont ribute to the toxicity of the uremic syndrome, We reviewed the course of patients maintained by hemodialysis (MD) and peritoneal dialysis (P D) to detect any correlation between the level of PTH when beginning d ialytic therapy and subsequent morbidity and mortality, Study cohorts consisted of 175 HD and 113 PD patients followed for up to 9 years. De mographic characteristics such as age, race, gender, diabetic status, and prior months on dialysis, as well as biochemical parameters includ ing albumin, creatinine, cholesterol, intact PTH, calcium, and phospho rus levels at enrollment were evaluated for their effect on patient su rvival, Expected survival was calculated by Cox proportional hazards a nalysis, Older age and lower enrollment serum creatinine level were as sociated with increased mortality in both HD and PD patients, whereas low serum albumin and low serum chotesterol levels also predicted high mortality in HD patients. In both HD and PD, patients with enrollment PTH level of less than or equal to 65 pg/mL; had more than twice the mortality risk of those with PTH greater than or equal to 200 pg/mL. B oth observed and expected survival of patients with low PTH were signi ficantly lower than the survival in patients with higher PTH, Five-yea r HD survivors and four-year PD survivors had significantly higher PTH levels at initiation of dialytic therapy than did those with shorter survival. PTH level correlated with serum creatinine and serum albumin in HD but only with serum creatinine in PD, supporting the inference that patients with high enrollment PTH were better nourished than thos e with lower PTH. (C) 1996 by the National Kidney Foundation, Inc.