Impact of age on survival predictability of bone turnover markers in hemodialysis patients

Abstract

BackgroundAbnormalities in serum alkaline phosphatase (ALP) and intact parathyroid hormone (PTH) concentrations, as biochemical markers of bone turnover in dialysis patients, correlate with increased mortality in maintenance hemodialysis (MHD) patients. Changes in bone turnover rate vary with age. The mortality predictability of serum ALP and PTH levels in MHD patients may be different across ages.MethodsWe examined differences across four age groups (18 to <45, 45 to <65, 65 to <75 and ≥75 years) in the mortality predictability of serum ALP and PTH in 102 149 MHD patients using Cox models.ResultsHigher serum ALP levels were associated with higher mortality across all ages; however, the ALP-mortality association was much stronger in young patients (<45 years) compared with older patients. The association between higher serum PTH levels and mortality was stronger in older patients compared with the younger groups. Serum PTH levels were incrementally associated with mortality only in middle-aged and elderly patients (≥45 years). Compared with patients with serum PTH 150 to <300pg/mL, the death risks were higher in patients with serum PTH 300 to <600pg/mL [HRs (95% CI): 1.05 (1.01-1.10), 1.15 (1.10-1.21) and 1.25 (1.19-1.31) for patients 45 to <65, 65 to <75 and ≥75 years, respectively], and ≥600pg/mL [HRs(95% CI): 1.07 (1.01-1.14), 1.31(1.21-1.42) and 1.45(1.33-1.59) for age categories 45 to <65, 65 to <75 and ≥75 years, respectively]. However, no significant association between higher serum PTH levels and mortality was observed in patients <45 years.ConclusionsThere are important differences in mortality-predictability of serum ALP and PTH in older MHD patients compared with their younger counterparts. The effect of age needs to be considered when interpreting the prognostic implications of serum ALP and PTH levels. © 2013 The Author. All rights reserved.