Abstract
This Practice Point commentary discusses the findings and limitations of a cohort study reported by Wald and colleagues of mineral metabolism in patients on hemodialysis. The investigators' observational analysis utilized data from the 1,846 patients in the randomized, controlled Hemodialysis (HEMO) Study. Wald et al.'s advantages include the well-characterized dataset, particularly with regard to comorbid conditions. However, the authors found it impossible to analyze the potentially confounding effect of concomitant medications. Furthermore, the relatively small dataset, especially compared with those of previous studies, limits the power of this study. In summary, Wald et al.'s findings support earlier studies confirming the importance of mineral metabolism as a risk factor for mortality in patients on hemodialysis. However, because of its low statistical power, its lack of analysis of potentially important confounders, and its observational design, the study cannot provide appropriate targets and should not serve as a justification for tolerating mild hyperphosphatemia or hypercalcemia or for overlooking the importance of preventing secondary hyperparathyroidism.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Block GA et al. (1998) Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 31: 607–617
Block GA et al. (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 15: 2208–2218
Kalantar-Zadeh K et al. (2006) Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int 70: 771–780
Wald R et al. (2007) Impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in a large dialysis network. Am J Kidney Dis 49: 257–266
Tentori F et al. (2008) Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Pattern Study (DOPPS). Am J Kidney Dis 52: 519–530
Wald R et al. (2008) Disordered mineral metabolism in hemodialysis patients: an analysis of cumulative effects in the Hemodialysis (HEMO) Study. Am J Kidney Dis 52: 531–540
National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42 (Suppl 3): S1–S201
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author has declared associations with the following companies: Abbott (as consultant and grant/research support recipient), Amgen (as consultant, member of speakers bureau and grant/research support recipient), Genentech (as grant/research support recipient), Genzyme (as consultant and member of speakers bureau), INEOS (as grant/research support recipient) and Nephro-Tech (as grant/research support recipient).
Rights and permissions
About this article
Cite this article
Spiegel, D. Interpreting observational studies of disordered mineral metabolism and mortality in patients on hemodialysis. Nat Rev Nephrol 5, 16–17 (2009). https://doi.org/10.1038/ncpneph0992
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0992
This article is cited by
-
Pharmacological Agents Targeting Myocardial Metabolism for the Management of Chronic Stable Angina : an Update
Cardiovascular Drugs and Therapy (2016)