Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease a systematic review and meta-analysis

Palmer, SC; Hayen, A; Macaskill, P; Pellegrini, F; Craig, JC; Elder, GJ; Strippoli, GFM

Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease a systematic review and meta-analysis

Palmer, SC Hayen, A

Macaskill, P Pellegrini, F Craig, JC Elder, GJ Strippoli, GFM

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Publication Type:: Journal Article
Citation:: JAMA - Journal of the American Medical Association, 2011, 305 (11), pp. 1119 - 1127
Issue Date:: 2011-03-16

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Field	Value	Language
dc.contributor.author	Palmer, SC	en_US
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030	en_US
dc.contributor.author	Macaskill, P	en_US
dc.contributor.author	Pellegrini, F	en_US
dc.contributor.author	Craig, JC	en_US
dc.contributor.author	Elder, GJ	en_US
dc.contributor.author	Strippoli, GFM	en_US
dc.date.issued	2011-03-16	en_US
dc.identifier.citation	JAMA - Journal of the American Medical Association, 2011, 305 (11), pp. 1119 - 1127	en_US
dc.identifier.issn	0098-7484	en_US
dc.identifier.uri	http://hdl.handle.net/10453/117870
dc.description.abstract	Context: Clinical practice guidelines on the management of mineral and bone disorders due to chronic kidney disease recommend specific treatment target levels for serum phosphorus, parathyroid hormone, and calcium. Objective: To assess the quality of evidence for the association between levels of serum phosphorus, parathyroid hormone, and calcium and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in individuals with chronic kidney disease. Data Sources: The databases of MEDLINE (1948 to December 2010) and EMBASE (1947 to December 2010) were searched without language restriction. Hand searches also were conducted of the reference lists of primary studies, review articles, and clinical guidelines along with full-text review of any citation that appeared relevant. Study Selection: Of 8380 citations identified in the original search, 47 cohort studies (N=327 644 patients) met the inclusion criteria. Data Extraction: The characteristics of study design, participants, exposures, and covariates together with the outcomes of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events at different levels of serum phosphorus, parathyroid hormone, and calcium were analyzed within studies. Data were summarized across studies (when possible) using random-effects meta-regression. Data Synthesis: The risk of death increased 18% for every 1-mg/dL increase in serum phosphorus (relative risk [RR], 1.18 [95% confidence interval {CI}, 1.12-1.25]). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01 [95% CI, 1.00-1.02]) or serum level of calcium (RR per 1-mg/dL increase, 1.08 [95% CI, 1.00-1.16]). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies. Conclusions: The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population. ©2011 American Medical Association. All rights reserved.	en_US
dc.relation.ispartof	JAMA - Journal of the American Medical Association	en_US
dc.relation.isbasedon	10.1001/jama.2011.308	en_US
dc.subject.classification	General & Internal Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Kidney Failure, Chronic	en_US
dc.subject.mesh	Cardiovascular Diseases	en_US
dc.subject.mesh	Metabolic Diseases	en_US
dc.subject.mesh	Calcium	en_US
dc.subject.mesh	Phosphorus	en_US
dc.subject.mesh	Parathyroid Hormone	en_US
dc.subject.mesh	Biomarkers	en_US
dc.subject.mesh	Mortality	en_US
dc.subject.mesh	Practice Guidelines as Topic	en_US
dc.subject.mesh	Predictive Value of Tests	en_US
dc.subject.mesh	Prognosis	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	United States	en_US
dc.title	Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease a systematic review and meta-analysis	en_US
dc.type	Journal Article
utslib.citation.volume	11	en_US
utslib.citation.volume	305	en_US
utslib.for	110312 Nephrology and Urology	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	open_access
pubs.issue	11	en_US
pubs.publication-status	Published	en_US
pubs.volume	305	en_US

Abstract:

Context: Clinical practice guidelines on the management of mineral and bone disorders due to chronic kidney disease recommend specific treatment target levels for serum phosphorus, parathyroid hormone, and calcium. Objective: To assess the quality of evidence for the association between levels of serum phosphorus, parathyroid hormone, and calcium and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in individuals with chronic kidney disease. Data Sources: The databases of MEDLINE (1948 to December 2010) and EMBASE (1947 to December 2010) were searched without language restriction. Hand searches also were conducted of the reference lists of primary studies, review articles, and clinical guidelines along with full-text review of any citation that appeared relevant. Study Selection: Of 8380 citations identified in the original search, 47 cohort studies (N=327 644 patients) met the inclusion criteria. Data Extraction: The characteristics of study design, participants, exposures, and covariates together with the outcomes of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events at different levels of serum phosphorus, parathyroid hormone, and calcium were analyzed within studies. Data were summarized across studies (when possible) using random-effects meta-regression. Data Synthesis: The risk of death increased 18% for every 1-mg/dL increase in serum phosphorus (relative risk [RR], 1.18 [95% confidence interval {CI}, 1.12-1.25]). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01 [95% CI, 1.00-1.02]) or serum level of calcium (RR per 1-mg/dL increase, 1.08 [95% CI, 1.00-1.16]). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies. Conclusions: The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population. ©2011 American Medical Association. All rights reserved.

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http://hdl.handle.net/10453/117870