演題情報

学会・委員会企画

開催回
第56回・2011年・横浜
 

Survival of Dialysis Patients: What Can We Do for It?

演題番号 : GI-7-2

Kamyar Kalantar-Zadeh:1

1:University of California Los Angeles (UCLA), Harbor-UCLA Hospital, Harold Simmons Center

 

In Americas, Europe, and Japan annual national dialysis patient mortality is approximately 19-23%, 13-17%, and 6-9%, respectively. Whereas the exceptionally high transplant rate in the United States removes the healthiest patients leading to higher mortality in the remainders, this alone cannot explain the substantially greater survival in Japan. Japanese patients have lower serum PTH, which is probably not inherent but due to JSDT guidelines that recommend targeting PTH of 60-180 pg/ml. It is likely, although not yet well proven, that Japanese patients receive higher doses of such medications as vitamin D analogs and calcimimetics in order to achieve a lower PTH level as compared to other nations, which may be related to greater survival. African American dialysis patients in the USA have higher PTH and are more likely to receive vitamin D analogs and at higher doses. This may explain the greater survival of African American dialysis patients compared to Whites. In addition to PTH, there may be additional racial and ethnic disparities across minerals and alkaline phosphatase. Calcium disarrays and hyperphosphatemia (above 5.5 mg/dL) are also common in dialysis patients and associated with poor outcomes. Hyperphosphatemia may be related to increased dietary protein intake and higher death risk. However, protein-energy wasting is another common and usually associated with hypoalbuminemia, poor appetite and mortality. We have found that dialysis patients whose dietary protein intake is low have higher mortality even if phosphorus drops; and patients who had higher dietary phosphorus intake had incrementally higher mortality.

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