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Nitta Kosaku
Department Other, Other Position |
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| Article types | Original article |
| Language | English |
| Peer review | Non peer reviewed |
| Title | Hypocalcemia and cardiovascular mortality in cinacalcet users |
| Journal | Formal name：Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Abbreviation：Nephrol Dial Transplant ISSN code：14602385/09310509 |
| Volume, Issue, Page | 39(4),pp.637-647 |
| Author and coauthor | Goto Shunsuke, Hamano Takayuki, Fujii Hideki, Taniguchi Masatomo, Abe Masanori, Nitta Kosaku, Nishi Shinichi |
| Publication date | 2024/03/27 |
| Summary | BACKGROUND:Calcimimetics are widely used in hemodialysis patients and influence serum calcium levels. Although the Kidney Disease Improving Global Outcomes guidelines argued that low calcium levels induced by calcimimetics may be harmless, large observational studies investigating the association between hypocalcemia and mortality are scarce. We investigated the association between serum calcium levels and cardiovascular mortality in calcimimetics users using the nationwide Japanese registry for dialysis patients.METHODS:In this 9-year prospective cohort study, the baseline data were collected at the end of 2009. We enrolled patients on maintenance hemodialysis or hemodiafiltration. We employed three models (baseline, time-dependent, and time-average) to conduct Cox proportional hazard regression analyses.RESULTS:Cinacalcet was prescribed to 12.7% (N = 22 853) at baseline. The median observation period was 98 (interquartile range, 40-108) months and 108 (interquartile range, 59-108) months in the whole cohort (N = 180 136) and in cinacalcet users, respectively. Three quarters of survivors at the end of 2019 had continued calcimimetic therapy for 10 years, corresponding to mean annual dropout rate of 2.9%. Hypocalcemia was not associated with cardiovascular mortality in the baseline or time-average model. In the time-dependent model, however, the lowest calcium decile (corrected calcium < 8.4 mg/dL) was significantly associated with higher cardiovascular mortality than the reference (corrected calcium 8.7-8.9 mg/dL) in both cinacalcet users and all patients (hazard ratio (95% confidence interval), 1.32 (1.00, 1.75) and 1.15 (1.05, 1.26), respectively). Hypocalcemia was especially associated with sudden death and death due to hemorrhagic stroke, heart failure, and ischemic heart disease. Higher rate of fatal and non-fatal cardiovascular events was observed in hypocalcemic patients regardless of cinacalcet usage.CONCLUSIONS:Our findings suggest that transient hypocalce |
| DOI | 10.1093/ndt/gfad213 |
| PMID | 37777840 |