HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Komaba H, Zhao J, Yamamoto S, et al.

Secondary Hyperparathyroidism Is Associated with Weight Loss and Longer-Term Mortality Among Patients Undergoing Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:5A 2020

BACKGROUND

Wasting is a common complication of kidney failure that leads to weight loss and poor outcomes. Recent experimental data identified parathyroid hormone (PTH) as a driver of adipose tissue browning and wasting, but little is known about the relations among secondary hyperparathyroidism (SHPT), weight loss, and risk of mortality in patients undergoing hemodialysis.

METHODS

We included 42,319 participants receiving hemodialysis for at least one year in the DOPPS phases 2-6 (2002-2018). Linear mixed models were used to estimate the association between baseline PTH and percent weight change over 12 months, adjusting for country, demographics, comorbidities, and labs. Accelerated failure time models were used to assess 12-month weight loss as a mediator between baseline high PTH and mortality after 12 months.

RESULTS

At baseline, mean (SD) body weight was 74 (22) kg and the median PTH level was 251 pg/mL (interquartile range [IQR], 131-444 pg/mL). Baseline PTH was inversely associated with 12-month weight change: 12-month weight loss >5% was observed in 21%, 18%, 18%, 17%, 16%, and 14% of patients for PTH ≥600 pg/mL, 450-600, 300-450, 150-300, 50-150, and <50 pg/mL, respectively. In adjusted analysis, 12-month weight change compared to PTH 150-299 pg/mL was - 0.60%, -0.12%, -0.10%, +0.15%, and +0.35% for PTH ≥600, 450-600, 300-450, 50-150, and <50 pg/mL, respectively (P<0.01). Interacting baseline PTH*appetite, high PTH was associated with weight loss only in persons with preserved appetite (P<0.01). During follow-up after the 12-month weight measure (median, 1.0 [IQR, 0.6-1.7] years; 6125 deaths), patients with baseline PTH ≥600 pg/mL had 11% (95% CI, 9-13%) shorter lifespan, and 18% (95% CI,14-23%) of this effect was mediated through weight loss ≥2.5%.

CONCLUSION

Our findings indicate that SHPT may be a novel mechanism of wasting in dialysis patients, corroborating experimental data, and that this pathway may be a mediator between elevated PTH levels and mortality. Future research should determine whether PTH-lowering therapy can limit or prevent weight loss and improve longer-term dialysis outcomes.

c Copyright 2020 -2021 American Society of Nephrology. Reproduced with permission.
All ASN abstracts from the 2020 Annual Meeting are available at this link and also are archived in .pdf form at ASN-Online.org

Disclaimer: Abstracts often have errors, both typographical and otherwise. This posting is an electronic translation of submitted abstracts which has not been verified against the original submitted abstract nor with the authors for accuracy. As a result, there may be errors, especially with regard to drug doses, but not limited to these. Abstracts undergo only limited review, and data often are changed as a result of the peer review process, so their reliability is less than manuscripts published in peer-reviewed journals. In using these summaries, you are agreeing that you are aware of these limitations.

The materials are provided on an as-is basis without any warranty of any kind, either express or implied. In addition to errors, the information presented may be incomplete or outdated. The information contained is not intended nor recommended as a substitute for professional medical advice. You are advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device to be used or drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug, disease, and the best treatment for the patient.

To the fullest extent permitted by law, HDCN, ASN and their affiliates and suppliers disclaim all warranties, express or implied, including, but not limited to, any warranty of merchantability, non- infringement or fitness for a particular purpose.

In no event shall HDCN, ASN, or their affiliates or suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, goodwill or other intangibles) arising from or in any way relating to these terms, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not any or all of the limited entities is advised of the possibility of such damages.