Linked Life Data

16820797

Source:http://linkedlifedata.com/resource/pubmed/id/16820797

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PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
4
pubmed:dateCreated
2006-8-10
pubmed:abstractText
Although renal osteodystrophy and vitamin D analogs may be related to survival in maintenance hemodialysis (MHD) patients, most studies have examined associations between baseline values and survival without accounting for variations in clinical and laboratory measures over time. We examined associations between survival and quarterly laboratory values and administered paricalcitol in a 2-year (July 2001-June 2003) cohort of 58,058 MHD patients from all DaVita dialysis clinics in USA using both time-dependent Cox models with repeated measures and fixed-covariate Cox models with only baseline values. Whereas hypercalcemia and hyperphosphatemia were robust predictors of higher death risk in all models, the association between serum calcium and mortality was different in time-varying models. Changes in baseline calcium and phosphorus values beyond the Kidney Disease Outcome Quality Initiative recommended targets were associated with increased mortality. Associations between high serum parathyroid hormone and increased death risk were masked by case-mix characteristics of MHD patients. Time-varying serum alkaline phosphatase had an incremental association with mortality. Administration of any dose of paricalcitol was associated with improved survival in time-varying models. Controlling for nutritional markers may introduce overadjustment bias owing to their strong collinearity with osteodystrophy surrogates. Whereas both time-dependent and fixed-covariate Cox models result in similar associations between osteodystrophy indicators and survival, subtle but potentially clinically relevant differences between the two models exist, probably because fixed models do not account for variations of osteodystrophy indices and changes in medication dose over time.
pubmed:grant
pubmed:commentsCorrections
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Aug
pubmed:issn
0085-2538
pubmed:author
pubmed:issnType
Print
pubmed:volume
70
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
771-80
pubmed:dateRevised
2007-11-14
pubmed:meshHeading
pubmed-meshheading:16820797-Aged, pubmed-meshheading:16820797-Alkaline Phosphatase, pubmed-meshheading:16820797-Calcium, pubmed-meshheading:16820797-Ergocalciferols, pubmed-meshheading:16820797-Female, pubmed-meshheading:16820797-Humans, pubmed-meshheading:16820797-Kidney Diseases, pubmed-meshheading:16820797-Male, pubmed-meshheading:16820797-Middle Aged, pubmed-meshheading:16820797-Multivariate Analysis, pubmed-meshheading:16820797-Parathyroid Hormone, pubmed-meshheading:16820797-Phosphorus, pubmed-meshheading:16820797-Predictive Value of Tests, pubmed-meshheading:16820797-Proportional Hazards Models, pubmed-meshheading:16820797-Renal Dialysis, pubmed-meshheading:16820797-Renal Osteodystrophy, pubmed-meshheading:16820797-Risk Factors, pubmed-meshheading:16820797-Survival Analysis, pubmed-meshheading:16820797-Time Factors
pubmed:year
2006
pubmed:articleTitle
Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients.
pubmed:affiliation
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA. kamkal@ucla.edu
pubmed:publicationType
Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural