TY - JOUR
T1 - Association between Chronic Kidney Disease-Mineral and Bone Disorder Biomarkers and Symptom Burden in Older Patients with Advanced Chronic Kidney Disease Results from the EQUAL Study
AU - Magagnoli, Lorenza
AU - Cozzolino, Mario
AU - Evans, Marie
AU - Caskey, Fergus J.
AU - Dekker, Friedo W.
AU - Torino, Claudia
AU - Szymczak, Maciej
AU - Drechsler, Christiane
AU - Pippias, Maria
AU - Vilasi, Antonio
AU - Janse, Roemer J.
AU - Krajewska, Magdalena
AU - Stel, Vianda S.
AU - Jager, Kitty J.
AU - Chesnaye, Nicholas C.
AU - Schneider, Andreas
AU - Torp, Anke
AU - Iwig, Beate
AU - Perras, Boris
AU - Marx, Christian
AU - Blaser, Christof
AU - Wanner, Christoph
AU - Emde, Claudia
AU - Krieter, Detlef
AU - Fuchs, Dunja
AU - Irmler, Ellen
AU - Platen, Eva
AU - Schmidt-Gürtler, Hans
AU - Schlee, Hendrik
AU - Naujoks, Holger
AU - Schlee, Ines
AU - Cäsar, Sabine
AU - Beige, Joachim
AU - Röthele, Jochen
AU - Mazur, Justyna
AU - Hahn, Kai
AU - Blouin, Katja
AU - Neumeier, Katrin
AU - Anding-Rost, Kirsten
AU - Schramm, Lothar
AU - Hopf, Monika
AU - Wuttke, Nadja
AU - Frischmuth, Nikolaus
AU - Ichtiaris, Pawlos
AU - Kirste, Petra
AU - Schulz, Petra
AU - Aign, Sabine
AU - Gaillard, Carlo
AU - Voskamp, Pauline
AU - Blankestijn, Peter
N1 - Publisher Copyright:
© 2024 by the American Society of Nephrology.
PY - 2024/10
Y1 - 2024/10
N2 - Background Patients with advanced CKD develop numerous symptoms, with a multifactorial origin. Evidence linking mineral disorders (CKD-Mineral and Bone Disorder) and uremic symptoms is scant and mostly limited to dialysis patients. Here, we aim to assess the association between CKD-Mineral and Bone Disorder and symptom burden in nondialysis patients with CKD. Methods We used data from the European Quality study, which includes patients aged $65 years with eGFR #20 ml/min per 1.73 m2 from six European countries, followed up to 5 years. We used generalized linear mixed-effect models to determine the association between repeated measurements of parathyroid hormone (PTH), phosphate, and calcium with the overall symptom number (0–33), the overall symptom severity (0–165), and the presence of 33 CKD-related symptoms. We also analyzed subgroups by sex, age, and diabetes mellitus and assessed effect mediation and joint effects between mineral biomarkers. Results The 1396 patients included in the study had a mean of 1366 symptoms at baseline, with a median overall severity score of 32 (interquartile range, 19–50). The association between PTH levels and symptom burden appeared U-shaped with a lower symptom burden found for mild-to-moderately increased PTH levels. Phosphate and calcium were not independently associated with overall symptom burden. The highest symptom burden was found in patients with a combination of both severe hyperparathyroidism and severe hyperphosphatemia (12.44 symptoms [0.50–4.38], P 5 0.01). The association of both hypocalcemia and hyperphosphatemia with symptom burden seemed to differ by sex and age. Conclusions In older patients with advanced CKD not on dialysis, mild-to-moderately increased PTH was associated with a lower symptom burden, although the effect size was relatively small (less than one symptom). Neither phosphate nor calcium were associated with the overall symptom burden, except for the combination of severe hyperphosphatemia and severe hyperparathyroidism which was associated with an increased number of symptoms.
AB - Background Patients with advanced CKD develop numerous symptoms, with a multifactorial origin. Evidence linking mineral disorders (CKD-Mineral and Bone Disorder) and uremic symptoms is scant and mostly limited to dialysis patients. Here, we aim to assess the association between CKD-Mineral and Bone Disorder and symptom burden in nondialysis patients with CKD. Methods We used data from the European Quality study, which includes patients aged $65 years with eGFR #20 ml/min per 1.73 m2 from six European countries, followed up to 5 years. We used generalized linear mixed-effect models to determine the association between repeated measurements of parathyroid hormone (PTH), phosphate, and calcium with the overall symptom number (0–33), the overall symptom severity (0–165), and the presence of 33 CKD-related symptoms. We also analyzed subgroups by sex, age, and diabetes mellitus and assessed effect mediation and joint effects between mineral biomarkers. Results The 1396 patients included in the study had a mean of 1366 symptoms at baseline, with a median overall severity score of 32 (interquartile range, 19–50). The association between PTH levels and symptom burden appeared U-shaped with a lower symptom burden found for mild-to-moderately increased PTH levels. Phosphate and calcium were not independently associated with overall symptom burden. The highest symptom burden was found in patients with a combination of both severe hyperparathyroidism and severe hyperphosphatemia (12.44 symptoms [0.50–4.38], P 5 0.01). The association of both hypocalcemia and hyperphosphatemia with symptom burden seemed to differ by sex and age. Conclusions In older patients with advanced CKD not on dialysis, mild-to-moderately increased PTH was associated with a lower symptom burden, although the effect size was relatively small (less than one symptom). Neither phosphate nor calcium were associated with the overall symptom burden, except for the combination of severe hyperphosphatemia and severe hyperparathyroidism which was associated with an increased number of symptoms.
UR - https://www.scopus.com/pages/publications/85199974198
U2 - 10.2215/CJN.0000000000000510
DO - 10.2215/CJN.0000000000000510
M3 - Article
C2 - 39037951
AN - SCOPUS:85199974198
SN - 1555-9041
VL - 19
SP - 1240
EP - 1252
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 10
ER -