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Kidney Res Clin Pract. 2018 Sep;37(3):266-276. doi: 10.23876/j.krcp.2018.37.3.266. Epub 2018 Sep 30.

Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry.

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Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
Department of Internal Medicine, Gangneung Dongin Hospital, Gangneung, Korea.
Department of Internal Medicine, J Hospital, Seongnam, Korea.
Division of Nephrology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
School of Medicine, Inha University, Incheon, Korea.
Department of Prevention and Management, Inha University Hospital, Incheon, Korea.
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.



We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients.


Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed.


Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; P = 0.003).


In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.


Calcium; Hemodialysis; Mortality; Parathyroid hormone; Phosphorus

Conflict of interest statement

Conflicts of interest All authors have no conflicts of interest to declare.

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