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Sircuța AF, Grosu ID, Schiller A, Petrica L, Ivan V, Schiller O, Maralescu FM, Palamar M, Mircea MN, Nișulescu D, Goleț I, Bob F. Associations Between Inflammatory and Bone Turnover Markers and Mortality in Hemodialysis Patients. Biomedicines 2025; 13:1163. [PMID: 40426990 PMCID: PMC12109441 DOI: 10.3390/biomedicines13051163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 04/30/2025] [Accepted: 05/07/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Chronic kidney disease-mineral and bone disorder (CKD-MBD) and systemic inflammation contribute to mortality in hemodialysis (HD) patients. The primary aim of this study was to determine whether specific CKD-MBD markers and inflammatory biomarkers are associated with increased mortality risk in HD patients. Methods: We conducted a retrospective cohort study on 63 stage 5D CKD patients undergoing maintenance HD. Serum intact parathyroid hormone (iPTH), soluble Klotho, calcium, phosphorus, 25(OH)D (25-hydroxyvitamin D), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), and interleukin-6 (IL-6) were analyzed. A Cox regression analysis assessed mortality predictors, and linear regression analysis evaluated CKD-MBD-inflammation correlations. Results: Lower iPTH (<329.3 pg/mL) levels were the only significant mortality predictor (p = 0.042). Other CKD-MBD markers (calcium, phosphorus, 25(OH)D, VEGF, TGF-β) did not impact survival. Soluble Klotho correlated positively with IL-6 (r = 0.57, p < 0.001), suggesting a compensatory inflammatory response. Conclusions: Our findings demonstrate that low iPTH levels and advanced age are independent predictors of mortality in hemodialysis patients. The positive association between soluble Klotho and IL-6 suggests a potential compensatory inflammatory response. These results highlight the need for further research to clarify underlying mechanisms and to explore novel therapeutic strategies.
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Affiliation(s)
- Alexandru Florin Sircuța
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- County Emergency Hospital, L. Rebreanu Street, Nr. 156, 300723 Timișoara, Romania;
| | - Iulia Dana Grosu
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- County Emergency Hospital, L. Rebreanu Street, Nr. 156, 300723 Timișoara, Romania;
| | - Adalbert Schiller
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ligia Petrica
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- County Emergency Hospital, L. Rebreanu Street, Nr. 156, 300723 Timișoara, Romania;
| | - Viviana Ivan
- County Emergency Hospital, L. Rebreanu Street, Nr. 156, 300723 Timișoara, Romania;
- Department of Internal Medicine II—Cardiology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Oana Schiller
- B Braun Avitum Dialysis Centre, 300417 Timișoara, Romania;
| | - Felix-Mihai Maralescu
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- County Emergency Hospital, L. Rebreanu Street, Nr. 156, 300723 Timișoara, Romania;
| | - Marcel Palamar
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Monica-Nicoleta Mircea
- Institute of Cardiovascular Diseases Timișoara, 13A Gheorghe Adam Street, 300310 Timișoara, Romania; (M.-N.M.); (D.N.)
| | - Daniel Nișulescu
- Institute of Cardiovascular Diseases Timișoara, 13A Gheorghe Adam Street, 300310 Timișoara, Romania; (M.-N.M.); (D.N.)
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timișoara, Romania
| | - Ionuț Goleț
- Department of Management, Faculty of Economics and Business Administration, University of the West, 300115 Timișoara, Romania;
| | - Flaviu Bob
- Department of Internal Medicine II—Nephrology University Clinic, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (A.F.S.); (A.S.); (L.P.); (F.-M.M.); (M.P.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- County Emergency Hospital, L. Rebreanu Street, Nr. 156, 300723 Timișoara, Romania;
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Roggeri A, Conte F, Rossi C, Cozzolino M, Zocchetti C, Roggeri DP. Cinacalcet adherence in dialysis patients with secondary hyperparathyroidism in Lombardy Region: clinical implications and costs. Drugs Context 2020; 9:dic-2020-1-1. [PMID: 32273898 PMCID: PMC7111129 DOI: 10.7573/dic.2020-1-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/01/2020] [Accepted: 03/06/2020] [Indexed: 01/16/2023] Open
Abstract
Background Patients on dialysis often have secondary hyperparathyroidism (SHPT), a disorder associated with renal osteodystrophy, progressive vascular calcification, cardiovascular disease, and death. The objective of this retrospective observational study was to evaluate, in dialysis patients with SHPT, the impact of different levels of adherence to cinacalcet therapy on hospitalisations and direct healthcare costs charged to the Lombardy Regional Health Service (Italy). Methods Data recorded in the administrative databases on all citizens undergoing dialysis between 1 January 2011 and 31 December 2011 were selected. For the aim of this study, patients with SHPT already on dialysis in the first 6 months of 2009 who had been treated with cinacalcet for at least 365 days were selected and retrospectively analysed through to end of 2012. Healthcare resource utilisation, cinacalcet adherence, and costs for medication, hospitalisations, and diagnostic/therapeutic procedures were estimated. Results A total of 994 patients were identified (mean age 63.0 years, females 43.5%). The first patient tertile had an adherence to cinacalcet of <64.1%, whereas the third had an adherence of over 91.5%. Patients in the third adherence tertile experienced fewer all-causes hospitalisations than those in the first tertile (-19.2%; p=0.01423), fractures (-37.1%; p=0.59422), cardiovascular disease (-23.8%; p=0.04025), and sepsis (-32.3%; p=0.01386). The increase in costs for cinacalcet-adherent patients is almost completely offset by the reduction in costs for hospitalisations. Conclusions The results of the analysis suggest that there may be some correlation between a high level of cinacalcet adherence and a decrease in hospitalisations.
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Affiliation(s)
| | - Ferruccio Conte
- Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
| | | | - Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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