Observational studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2023
Mineral and bone metabolism markers and mortality in diabetic patients on haemodialysis.
Observational study in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- [Switching patients from cinacalcet to etelcalcetide: evaluation of predictors of efficacy in a retrospective cohort study].Problemy endokrinologii · 2026Article
- Chronic kidney Disease overall survival prediction model based on frailty index score: construction and validation using NHANES data.Renal failure · 2025Article
- Patient characteristics modify the association between changes in mineral metabolism parameters and mortality in a nationwide hemodialysis cohort study.Scientific reports · 2025Article
- PTH may predict early mortality in incident patients on hemodialysis: results from a large cohort.International urology and nephrology · 2025Observational
- Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis.Clinical kidney journal · 2025Article
- Article
Corrections and comments
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Authors and funding
16 authors at 10 institutions in 5 countries.
Funding
Abstract
backgroundDiabetic patients on haemodialysis have a higher risk of mortality than non-diabetic patients. The aim of this COSMOS (Current management of secondary hyperparathyroidism: a multicentre observational study) analysis was to assess whether bone and mineral laboratory values [calcium, phosphorus and parathyroid hormone (PTH)] contribute to this risk.
methodsCOSMOS is a multicentre, open-cohort, 3-year prospective study, which includes 6797 patients from 227 randomly selected dialysis centres in 20 European countries. The association between mortality and calcium, phosphate or PTH was assessed using Cox proportional hazard regression models using both penalized splines smoothing and categorization according to KDIGO guidelines. The effect modification of the association between the relative risk of mortality and serum calcium, phosphate or PTH by diabetes was assessed.
resultsThere was a statistically significant effect modification of the association between the relative risk of mortality and serum PTH by diabetes (P = .011). The slope of the curve of the association between increasing values of PTH and relative risk of mortality was steeper for diabetic compared with non-diabetic patients, mainly for high levels of PTH. In addition, high serum PTH (>9 times the normal values) was significantly associated with a higher relative risk of mortality in diabetic patients but not in non-diabetic patients [1.53 (95% confidence interval 1.07-2.19) and 1.17 (95% confidence interval 0.91-1.52)]. No significant effect modification of the association between the relative risk of mortality and serum calcium or phosphate by diabetes was found (P = .2 and P = .059, respectively).
conclusionThe results show a different association of PTH with the relative risk of mortality in diabetic and non-diabetic patients. These findings could have relevant implications for the diagnosis and treatment of chronic kidney disease-mineral and bone disorders.
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