1. ¹Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia, USA
2. ²Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
3. ³Division of Nephrology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
4. ⁴Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, California, USA
5. ⁵David Geffen School of Medicine at UCLA, Los Angeles, California, USA

Correspondence: CP Kovesdy, Division of Nephrology, Salem Veterans Affairs Medical Center, 1970 Roanoke Blvd, Salem, Virginia 24153, USA. E-mail: csaba.kovesdy@va.gov

Received 6 September 2007; Revised 25 November 2007; Accepted 28 December 2007; Published online 12 March 2008.

Abstract

Secondary hyperparathyroidism is associated with mortality in patients undergoing maintenance dialysis treatment. We studied 515 male US veterans with chronic kidney disease, who were not yet on dialysis, to see what outcomes were associated with secondary hyperparathyroidism in this population. Relationships between intact parathyroid hormone levels and all-cause mortality along with the composite of mortality or incidence of dialysis were measured in unadjusted and adjusted Cox models for case-mix and laboratory variables. Elevated parathyroid hormone levels above the upper limit compared to the lower limit of the normal range were significantly associated with mortality after adjustments. Higher intact parathyroid hormone levels in the upper limit of normal were significantly associated with higher mortality overall and showed similar trends in subgroups of patients with stage 3 and stage 4–5 chronic kidney disease and with higher and lower serum calcium and phosphorus levels. Similar associations were found with the composite outcome of mortality or dialysis. Our study shows that secondary hyperparathyroidism is independently associated with higher mortality in patients with chronic kidney disease but not yet on dialysis.