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


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.


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.


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%.


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.

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