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Comparative Study
. 2018 Oct 5;19(1):253.
doi: 10.1186/s12882-018-1056-5.

Mineral and bone disorder management in hemodialysis patients: comparing PTH control practices in Japan with Europe and North America: the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Suguru Yamamoto  1 , Angelo Karaboyas  2 , Hirotaka Komaba  3 , Masatomo Taniguchi  4 , Takanobu Nomura  5 , Brian A Bieber  2 , Patricia De Sequera  6 , Anders Christensson  7 , Ronald L Pisoni  2 , Bruce M Robinson  2 , Masafumi Fukagawa  3
Affiliations
Comparative Study

Mineral and bone disorder management in hemodialysis patients: comparing PTH control practices in Japan with Europe and North America: the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Suguru Yamamoto et al. BMC Nephrol. .

Abstract

Background: High-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality.

Methods: We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-5 (2009-2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions (Europe/Australia/New Zealand [Eur/ANZ], Japan and North America) and dialysis vintage. Mortality rates were compared across PTH control categories using Cox regression models.

Results: Mean PTH was lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage < 90 days, PTH level was more likely to decline > 5% per month in Japan (48% of patients) versus Eur/ANZ (35%) and North America (35%). In patients with dialysis vintage > 1 year, Japanese patients maintained steady PTH, while patients in Eur/ANZ and North America were more likely to experience a PTH increase. Mean PTH was associated with mortality in the overall samples (highest mortality rate for PTH > 600 pg/mL, hazard ratio, 1.35; 95% confidence interval, 1.20 to 1.52 vs PTH 200-399 pg/mL), and the association was obvious in the prevalent patients (hazard ratio, 1.44; 95% confidence interval, 1.26 to 1.65). PTH slope and MSE did not show significant association with mortality in the overall sample as well as in subjects stratified both by region and dialysis vintage.

Conclusion: PTH control in hemodialysis patients, as measured by keeping a stable PTH level over 9 months, was observed in Japan contrasted with other regions. High PTH mean, but not increased PTH slope and MSE, was associated with mortality especially in prevalent patients.

Keywords: Dialysis outcomes and practice patterns study; Hemodialysis; Japanese society for Dialysis therapy; PTH slope; Parathyroid hormone.

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Conflict of interest statement

Ethics approval and consent to participate

IRB approval was obtained from E&I West Coast Board on May 23, 2016, IRB # IRB00007807. Written, informed consent was obtained from participants.

Consent for publication

Not applicable.

Competing interests

S.Y. has received honoraria from Kyowa Hakko Kirin. H.K. has received honoraria, consulting fees, and/or grant/research support from Bayer Yakuhin and Kyowa Hakko Kirin. M.T. has received consulting fees from Kyowa Hakko Kirin. T.N. is an employee of Kyowa Hakko Kirin. M.F. has received honoraria, consulting fees, and/or grant/research support from Astellas Pharma, Bayer Yakuhin, Kyowa Hakko Kirin, Ono Pharmaceutical, and Torii Pharmaceutical. A.K., B.A.B., R.L.P., and B.M.R. are employees for the non-profit research organization Arbor Research Collaborative for Health, which has designed and carries out the Dialysis Outcomes and Practice Patterns Study (DOPPS) Program. Grants are made to Arbor Research Collaborative for Health and not to individual investigators. The remaining authors have no conflicts to report.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Three measures of PTH control, by region and dialysis vintage. PTH control was defined as: (a) mean of absolute PTH (PTH mean); (b) slope of log (PTH) (PTH slope); and (c) mean squared error of PTH (PTH-MSE) over the 9 month run-in period. Each figure shows the distribution of PTH control by region [Europe/Australia/New Zealand (Eur/ANZ), North America and Japan] and dialysis vintage at DOPPS enrollment (< 90 days, 90 days-1 year and > 1 year)
Fig. 2
Fig. 2
Prescription of PTH-lowering therapies by region and dialysis vintage. The figure shows any prescription of active vitamin D or cinacalcet over the subsequent 9 month run-in period, by region [Europe/Australia/New Zealand (Eur/ANZ), North America and Japan] and dialysis vintage at DOPPS enrollment (< 90 days, 90 days-1 year and > 1 year)
See this image and copyright information in PMC

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