International Journal of Clinical Science and Medical Research

Background: Mineral and bone disorder (MBD) is a major contributor to cardiovascular mortality in end-stage kidney disease (ESKD). Classifying hemodialysis patients into phospho-calcic phenotypes may help identify those at highest risk.

Methods: A retrospective single-center study of 54 chronic hemodialysis patients at CHU Ibn Rochd (Casablanca), conducted over 12 months (January–December 2023). Patients were classified into 12 groups (36 phenotypes) based on averaged calcium, phosphorus, and PTH levels. Logistic regression was used to assess phenotype-mortality associations.

Results: Mean age was 46.9 years; mean HD vintage 13.31 years. Mean PTH was markedly elevated at 774.9 pg/mL. The largest group (38%) was Group 2 (high PTH, normal calcium, variable phosphorus). Six deaths occurred (11.1%), distributed across six different groups. No statistically significant association was found between phospho-calcic phenotype and mortality.

Conclusion: The limited sample size precluded the detection of a significant phenotype-mortality relationship. Larger multicenter studies are warranted to validate a phenotypic classification approach to MBD-related mortality risk in hemodialysis.

hemodialysis; mineral and bone disorder; phospho-calcic phenotype; PTH; cardiovascular mortality; CKD-MBD.

1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5 Suppl 3):S112–9.
2. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.
3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7(1):1–59.
4. Moe SM, Drueke T, Lameire N, Eknoyan G. Chronic kidney disease–mineral-bone disorder: a new paradigm. Adv Chronic Kidney Dis. 2007;14(1):3–12.
5. Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2008;52(3):519–30.
6.  Kestenbaum B, Sampson JN, Rudser KD, et al. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005;16(2):520–8.
7. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO4, Ca×PO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12(10):2131–8.
8. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18.
9. Karaboyas A, Zee J, Brunelli SM, et al. Understanding the recent increase in ferritin levels in United States dialysis patients: potential impact of changes in intravenous iron and erythropoiesis-stimulating agent practices. Am J Nephrol. 2015;42(6):425–33.
10. Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant. 2011;26(6):1948–55.
11. Barsoum RS. Chronic kidney disease in the developing world. N Engl J Med. 2006;354(10):997–9.
12. Uhlig K, Berns JS, Kestenbaum B, et al. KDOQI US commentary on the 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD-Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis. 2010;55(5):773–99.
13. Htay H, Cho Y, Pascoe EM, et al. Mineral and bone disorder in peritoneal dialysis patients: a cross-sectional analysis. Perit Dial Int. 2019;39(2):128–36.
14. Drueke TB, Massy ZA. Changing bone patterns with progression of chronic kidney disease. Kidney Int. 2016;89(2):289–302.
15. Nasrallah MM, El-Shehaby AR, Osman NA, et al. The effect of a new dialysate calcium concentration on mineral metabolism parameters and bone disease markers in hemodialysis patients. Nephron Clin Pract. 2010;116(3):c200–6.
16. Danese MD, Kim J, Doan QV, et al. PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis. 2006;47(1):149–56.