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Relationship between Parathyroid Hormone Levels and Hazards of Fracture, Vascular Events and Death in Stage 3 and 4 Chronic Kidney Disease

Sinong Geng, Zhaobin Kuang, View ORCID ProfilePeggy L. Peissig, View ORCID ProfileDavid Page, Laura Maursetter, View ORCID ProfileKaren E. Hansen
doi: https://doi.org/10.1101/480848
Sinong Geng
1Department of Computer Science, Princeton University,
MS
Roles: Graduate Student
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  • For correspondence: sgeng@cs.princeton.edu
Zhaobin Kuang
2Computer Science Department, Stanford University,
Ph.D.
Roles: Postdoctoral Researcher
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  • For correspondence: kuangz@stanford.edu
Peggy L. Peissig
3Marshfield Clinic Research Institute, Center for Computational and Biomedical Informatics,
Ph.D.,MBA
Roles: Research Scientist & Director
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  • ORCID record for Peggy L. Peissig
  • For correspondence: peissig.peggy@marshfieldclinic.org
David Page
4University of Wisconsin-Madison, Department of Biostatistics and Medical Informatics, Department of Computer Sciences,
PhD
Roles: Professor
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  • For correspondence: page@biostat.wisc.edu
Laura Maursetter
5Medicine, University of Wisconsin School of Medicine & Public Health, Department of Medicine,
DO
Roles: Assistant Professor
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  • For correspondence: lmaursetter@medicine.wisc.edu
Karen E. Hansen
6University of Wisconsin School of Medicine & Public Health, Department of Medicine,
MD,MS
Roles: Associate Professor
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  • For correspondence: keh@medicine.wisc.edu keh@medicine.wisc.edu
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Abstract

Background and Objectives: Chronic kidney disease (CKD) affects ∼20% of older adults and secondary hyperparathyroidism (HPT) is a common condition in these patients. Studies have linked HPT to a greater risk of fractures, vascular events and mortality. However, the optimal parathyroid hormone (PTH) level needed to minimize these events remains uncertain.

Design, setting, participants and measurements: We assessed relationships between baseline serum PTH levels and the subsequent 10-year probability of clinical fractures, vascular events and death in stage 3 and 4 CKD patients. We used Marshfield Clinic Health System electronic health records to analyze data from adult CKD patients spanning from 1985 to 2013. We required ≥2 PTH measurements at baseline and used ICD-9 codes to identify medical conditions, fractures, vascular events and death. In multivariate models, we assessed relationships between serum PTH and the three clinical outcomes, controlling for age, gender, co-morbidities and osteoporosis medication.

Results: 7594 subjects had a mean age of 68±13 years and 55% were women. Fractures, vascular events and death occurred in 19%, 60% and 29% of the cohort, respectively. In multivariate models including the whole cohort regardless of PTH assay, the probability of fracture, vascular events and death were minimized at a PTH of 23, 50 and 50 pg/mL. Below these cutpoints, the probability of fractures and death dramatically increased. When confining the analysis to patients measured using a 2nd generation PTH assay (n=5108), the hazards of fracture, vascular events and death were minimized at a PTH of zero, 60 and 58 pg/mL. Any of these clinical outcomes was minimized at a baseline PTH of 58 pg/mL.

Conclusions: Our study suggests that parathyroid hormone levels around 60 pg/mL might reduce the risk of fractures, vascular events and death in CKD patients. Additional epidemiologic studies and randomized clinical trials are needed to confirm these findings.

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Posted November 28, 2018.
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Relationship between Parathyroid Hormone Levels and Hazards of Fracture, Vascular Events and Death in Stage 3 and 4 Chronic Kidney Disease
Sinong Geng, Zhaobin Kuang, Peggy L. Peissig, David Page, Laura Maursetter, Karen E. Hansen
bioRxiv 480848; doi: https://doi.org/10.1101/480848
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Relationship between Parathyroid Hormone Levels and Hazards of Fracture, Vascular Events and Death in Stage 3 and 4 Chronic Kidney Disease
Sinong Geng, Zhaobin Kuang, Peggy L. Peissig, David Page, Laura Maursetter, Karen E. Hansen
bioRxiv 480848; doi: https://doi.org/10.1101/480848

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