Background
Materials and methods
Study design and participants
Data collection
Measurements
Statistical analysis
Results
Patient characteristics
Total N = 210 | |
---|---|
Age (years), median (IQR)
| 72 (62, 78.25) |
Sex, M/F (%)
| 131/79 (62.4/37.6) |
Dialysis vintage (months), median (IQR)
| 34 (20.75, 66) |
Nephropathy
-Diabetic -Nephrosclerosis -Glomerulonephritis -Autosomal dominant polycystic kidney disease (ADPKD) -Unknown etiology -Chronic tubulointerstitial nephritis | 89 (42.4) 35 (16.7) 26 (12.4) 15 (7.1) 32 (15.2) 13 (6.2) |
Diabetes, n(%)
| 99 (47.1) |
Hypertension, n(%)
| 201 (95.7) |
Smoking status, n(%)
| 80 (38.1) |
CAD, n(%)
| 82 (39) |
Cancer, n(%)
| 28 (13.3) |
Hepatitis B, n(%)
| 0 (0) |
Hepatitis C, n(%)
| 0 (0) |
Hemoglobin over one year, median (IQR)
Hemoglobin ≥ 11 g/dL, n(%)
Hemoglobin ≥ 10.5 g/dL, n(%)
| 11.27 (10.78, 11.78) 132 (62.9) 176 (83.8) |
Ferritin over one year, ng/mL, mean ± SD
| 533.89 ± 258.26 |
TSAT over one year, median (IQR)
TSAT ≥ 20%, n(%)
| 0.26 (0.21, 0.31) 172 (81.9) |
Serum calcium over one year, mg/dL, mean ± SD
| 9.01 ± 0.48 |
Serum phosphate over one year, mg/dL, mean ± SD
Serum phosphate < 5 mg/dL, n(%)
| 4.4 ± 1.1 175 (83.3) |
PTH, over one year, pg/mL, median (IQR)
| 232.4 (129.7, 413.2) |
URR over one year, mean ± SD
| 0.75 ± 0.05 |
Serum potassium over one year, median (IQR)
Serum potassium > 6meq/L, n(%)
| 5.11 (4.73, 5.45) 13 (6.2) |
RAAS inhibitors intake, n(%)
| 23 (11) |
Monthly dose of ESA over one year, UI, median (IQR)
| 21833.5 (14958.25, 40833.0) |
Monthly dose of IV Iron ampoules (100 mg) over one year, mean ± SD
| 1.15 ± 1.07 |
Weekly dose of alfacalcidol, µg, median (IQR)
| 1 (0, 2) |
Calcium-based phosphate binder (CBB), n(%)
| 172 (81.9) |
Non-calcium-based phosphate binder (NCBB), n(%)
| 94 (44.8) |
Yearly number of interventions in ESA prescription, mean ± SD
Median (IQR)
| 4.63 ± 2.62 5 (3, 7) |
Yearly number of interventions in IV iron prescription, mean ± SD
Median (IQR)
| 4.25 ± 0.1 4 (2, 6) |
Yearly number of interventions in alfacalcidol prescription, median (IQR)
| 0 (0, 1) |
Yearly number of interventions in CBB prescription, median (IQR)
| 0 (0, 2) |
Yearly number of interventions in NCBB prescription, median (IQR)
| 0 (0, 1) |
Yearly number of interventions in any phosphate binder prescription, median (IQR)
| 1 (0, 2.25) |
Yearly number of interventions in cinacalcet prescription, median (IQR)
| 0 (0, 0) |
Yearly number of interventions in kayexalate prescription, median (IQR)
| 0 (0, 0) |
Yearly number of interventions in potassium dialysate prescription, median (IQR)
| 0 (0, 1) |
Yearly number of interventions in session duration prescription, median (IQR)
| 0 (0, 0) |
Yearly number of interventions in filter surface prescription, median (IQR)
| 0 (0, 0) |
Clinical outcome 1: number of ESA interventions per year
With ≤ 5 interventions per year for ESA n = 120 | With > 5 interventions per year for ESA n = 90 | P-value | |
---|---|---|---|
Age, median (IQR)
| 72 (61, 78) | 72 (63, 79.3) | 0.422* |
Sex, M/F (%)
| 77/44 (64.2/35.8) | 54/36 (60/40) | 0.537** |
Dialysis vintage (months), Median (IQR)
| 40 (25, 72) | 31 (18, 49.3) | 0.011* |
Diabetes, n(%)
| 54 (45) | 45 (50) | 0.473** |
Hypertension, n(%)
| 116 (96.7) | 85 (94.4) | 0.502*** |
Smoking status, n(%)
| 50 (41.7) | 30 (33.3) | 0.218** |
CAD, n(%)
| 53 (44.2) | 29 (32.6) | 0.09** |
Cancer, n(%)
| 14 (11.7) | 14 (15.6) | 0.412** |
RAAS inhibitors intake, n(%)
| 12 (10) | 11 (12.2) | 0.61** |
Monthly dose of ESA, Median (IQR)
| 22333.5 (10,250, 45624.8) | 21,333 (17249.8, 37,500) | 0.853* |
Monthly dose of IV iron, Mean ± SD
| 1.04 ± 1.02 | 1.29 ± 1.13 | 0.005**** |
Yearly number of interventions in ESA prescription
Mean ± SD
| 2.8 ± 1.7 | 7.1 ± 1.1 | < 0.001**** |
Yearly number of interventions in IV iron prescription
Mean ± SD
| 3.7 ± 2.7 | 5.0 ± 2.1 | < 0.001**** |
Hemoglobin over one year, Median (IQR)
| 11.5 (10.9, 11.9) | 11.0 (10.6, 11.4) | < 0.001* |
Ferritin over one year, Mean ± SD
| 459.8 ± 260.9 | 633.8 ± 219.2 | < 0.001**** |
TSAT over one year, Median (IQR)
| 0.25 (0.20, 0.29) | 0.28 (0.22, 0.35) | 0.002* |
Serum calcium over one year, Mean ± SD
| 9.0 ± 0.5 | 9.0 ± 0.4 | 0.770**** |
Serum phosphate over one year, Mean ± SD
| 4.5 ± 1.04 | 4.3 ± 1.1 | 0.217**** |
PTH, over one year, Median (IQR)
| 270.0 (166.8, 509.0) | 175.4 (101.4, 312.7) | 0.001* |
URR over one year,
Mean ± SD
| 0.74 ± 0.05 | 0.77 ± 0.05 | 0.002**** |
Serum potassium over one year, Median (IQR)
| 5.1 (4.8, 5.6) | 5.1 (4.7, 5.4) | 0.215* |
OR | 95% CI | P-value | |
---|---|---|---|
Dialysis vintage
| 0.99 | 0.99; 1.01 | 0.544 |
ESA dose
| 1.00 | 1.00; 1.00 | 0.430 |
Iron dose
| 1.59 | 1.12; 2.25 | 0.010 |
Number of changes in iron prescription per year
| 1.23 | 1.08; 1.41 | 0.003 |
Hemoglobin level
| 0.91 | 0.62; 1.32 | 0.608 |
Ferritin level
| 1.004 | 1.002;1.005 | < 0.001 |
TSAT percentage
| 0.98 | 0.75; 1.26 | 0.855 |
PTH level
| 0.99 | 0.99; 1.00 | 0.048 |
URR percentage
| 1.06 | 0.99; 1.14 | 0.113 |
Clinical outcome 2: number of IV iron interventions per year
With ≤ 4 interventions per year and less for Iron n = 110 | With > 4 interventions per year for Iron n = 100 | p-value | |
---|---|---|---|
Age, median (IQR)
| 68 (61, 78) | 74 (65, 79.8) | 0.021* |
Sex, M/F (%)
| 72/38 (65.5/34.5) | 59/41 (59/41) | 0.335** |
Dialysis vintage (months), median (IQR)
| 36 (25, 67) | 32.5 (19, 64.3) | 0.234* |
Diabetes, n(%)
| 53 (48.2) | 46 (46) | 0.752** |
Hypertension, n(%)
| 106 (96.4) | 95 (95) | 0.739**** |
Smoking status, n(%)
| 37 (33.6) | 43 (43) | 0.163** |
CAD, n(%)
| 50 (45.5) | 32 (32) | 0.052** |
Cancer, n(%)
| 18 (16.4) | 10 (10) | 0.175** |
Monthly dose of ESA, median (IQR)
| 21,500 (14958.3, 44750.3) | 22,000 (14658.8, 37,875) | 0.612* |
Monthly dose of IV iron, mean ± SD
| 1.1 ± 1.04 | 1.2 ± 1.1 | 0.874*** |
Yearly number of interventions in ESA prescription
Mean ± SD
| 3.8 ± 2.6 | 5.5 ± 2.3 | < 0.001*** |
Yearly number of interventions in IV iron prescription
Mean ± SD
| 2.2 ± 1.3 | 6.5 ± 1.4 | < 0.001*** |
Hemoglobin over one year, median (IQR)
| 11.3 (10.8, 11.9) | 11.1 (10.8, 11.6) | 0.039* |
Ferritin over one year, Mean ± SD
| 508.2 ± 287.5 | 561.9 ± 220.1 | 0.134*** |
TSAT over one year, median (IQR)
| 0.25 (0.21, 0.30) | 0.26 (0.21, 0.32) | 0.423* |
URR over one year, mean ± SD
| 0.75 ± 0.05 | 0.76 ± 0.05 | 0.316*** |
Serum potassium over one year, median (IQR)
| 5.2 (4.8, 5.6) | 5.1 (4.6, 5.4) | 0.120* |
OR | 95% CI | P-value | |
---|---|---|---|
Age
| 1.03 | 1.003; 1.05 | 0.027 |
Hemoglobin level
| 0.93 | 0.69; 1.24 | 0.632 |
Number of changes in ESA prescription per year
| 1.31 | 1.15; 1.49 | < 0.001 |
Clinical outcome 3: number of phosphate binders’ interventions per year
With ≤ 1 interventions per year for phosphate binders n = 133 | With > 1 interventions per year for phosphate binders n = 77 | P-value | |
---|---|---|---|
Age, median (IQR)
| 72 (62, 80) | 70 (62, 77) | 0.284* |
Sex, M/F (%)
| 86/47 (64.7/35.3) | 45/32 (58.4/41.6) | 0.370** |
Dialysis vintage (months), median (IQR)
| 38 (25, 67) | 31 (17.5, 53.5) | 0.031* |
Diabetes, n(%)
| 59 (44.4) | 40 (51.9) | 0.289** |
Hypertension, n(%)
| 125 (94.9) | 76 (98.7) | 0.159*** |
Smoking status, n(%)
| 43 (32.3) | 37 (48.1) | 0.024** |
CAD, n(%)
| 57 (42.9) | 25 (32.9) | 0.156** |
Cancer, n(%)
| 17 (12.8) | 11 (14.3) | 0.757** |
Yearly number of interventions in alfacalcidol prescription,
median (IQR)
| 0 (0, 1) | 0 (0, 2) | 0.021* |
Hemoglobin over one year, median (IQR)
| 11.1 (10.6, 11.7) | 11.4 (10.9, 11.8) | 0.021* |
PTH over one year, median (IQR)
| 211.6 (97.5, 374.9) | 278.0 (174.5, 463.2) | 0.007* |
Serum calcium over one year, Mean ± SD
| 9.02 ± 0.43 | 8.99 ± 0.57 | 0.811**** |
Serum phosphate over one year, Mean ± SD
| 4.29 ± 1.13 | 4.59 ± 0.95 | 0.045**** |
URR over one year, Mean ± SD
| 0.76 ± 0.05 | 0.75 ± 0.05 | 0.099**** |
OR | 95% CI | P-value | |
---|---|---|---|
Dialysis vintage
| 0.99 | 0.99; 1.01 | 0.426 |
Smoking status
| 2.10 | 1.15; 3.86 | 0.017 |
Yearly number of interventions in alfacalcidol prescription
| 1.49 | 1.08; 2.06 | 0.015 |
Hemoglobin level
| 1.29 | 0.99; 1.69 | 0.057 |
PTH level
| 1.001 | 1.000; 1.002 | 0.199 |
Serum phosphate
| 1.18 | 0.88; 1.59 | 0.273 |
Clinical outcome 4: number of alfacalcidol interventions per year
With no interventions per year for Alfacalcidol n = 121 | With ≥ 1 interventions per year for Alfacalcidol n = 89 | P-value | |
---|---|---|---|
Age, median (IQR)
| 74 (64.5, 81) | 67 (60.5, 75) | < 0.001* |
Sex, M/F (%)
| 80/41 (66.1/33.9) | 51/38 (57.3/42.7) | 0.193** |
Dialysis vintage, median (IQR)
| 34 (20, 66) | 35 (21, 62) | 0.880* |
Diabetes, n(%)
| 61 (50.4) | 38 (42.7) | 0.268** |
Hypertension, n(%)
| 116 (95.9) | 85 (95.5) | 0.999*** |
Smoking status, n(%)
| 47 (38.8) | 33 (37.1) | 0.795** |
CAD, n(%)
| 46 (38) | 36 (40.9) | 0.672** |
Cancer, n(%)
| 15 (12.4) | 13 (14.6) | 0.642** |
Yearly number of interventions in phosphate binders’ prescription,
median (IQR)
| 1 (0, 2) | 1 (0, 3) | 0.199* |
Hb over one year, median (IQR)
| 11.3 (10.7, 11.8) | 11.3 (10.8, 11.6) | 0.881* |
PTH over one year, median (IQR)
| 207.6 (99.8, 299.2) | 338.5 (171.0, 555.7) | < 0.001* |
Serum calcium over one year, Mean ± SD
| 9.02 ± 0.49 | 8.99 ± 0.48 | 0.678**** |
Serum phosphate over one year, Mean ± SD
| 4.35 ± 1.08 | 4.48 ± 1.08 | 0.362**** |
URR over one year, Mean ± SD
| 0.76 ± 0.05 | 0.75 ± 0.05 | 0.070**** |