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  • Title: Interaction between parathyroid hormone and the Charlson comorbidity index on survival of incident haemodialysis patients.
    Author: Morrone LF, Mazzaferro S, Russo D, Aucella F, Cozzolino M, Facchini MG, Galfrè A, Malberti F, Mereu MC, Nordio M, Pertosa G, Santoro D, CPCP Study Investigators.
    Journal: Nephrol Dial Transplant; 2009 Sep; 24(9):2859-65. PubMed ID: 19369685.
    Abstract:
    BACKGROUND: Haemodialysis patients are ageing and have with a high rate of comorbidities. The impact of this novel clinical setting on intact parathyroid hormone (iPTH) is not well established. METHODS: For this observational, prospective multicentre cohort study, incident haemodialysis patients were recruited in 40 Italian centres and followed up for a mean period of 18 +/- 6.7 months. Clinical characteristics and biochemistry were recorded at baseline. Comorbid conditions were scored by the Charlson comorbidity index (CCI). RESULTS: Data of 411 patients (mean age: 66.5 +/- 14.8 years; 17.3% >80 years old) were recorded. The mean CCI was 4.17 +/- 2.8. In patients with CCI >0, an inverse correlation was observed between CCI (excluding age) and iPTH (P = 0.00002). Independently of CCI, patients with iPTH <150 pg/ml had 76% as high as the risk of all-cause mortality. After multivariable adjustment, the combination of the first tertile of iPTH with second and third tertiles of CCI was significantly associated with all-cause mortality (RR = 3.83, P = 0.02; RR = 3.79, P = 0.01, respectively). CONCLUSIONS: Incident haemodialysis patients suffer from a high rate of clinical complications. In these patients, low iPTH and high CCI are often associated and very likely responsible for an adverse outcome.
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