SynthesisBMC nephrology2013
Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis.
Synthesis in BMC nephrology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Quality of Life After Parathyroidectomy in Chronic Kidney Disease-Related Hyperparathyroidism: A Systematic Review and Meta-Analysis.World journal of surgery · 2026Pooled it
- Pooled it
- A Decision-Analytic Model to Assess the Cost-Effectiveness of Etelcalcetide vs. Cinacalcet.PharmacoEconomics · 2018Trial
- Effects of cinacalcet on atherosclerotic and nonatherosclerotic cardiovascular events in patients receiving hemodialysis: the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial.Journal of the American Heart Association · 2014Trial
- A Clinically Aligned Two-Stage Machine Learning Framework for Predicting Hungry Bone Syndrome After Parathyroidectomy.Endocrinology, diabetes & metabolism · 2026Article
- Low Time-Weighted Parathyroid Hormone Is Associated with Malnutrition-Inflammation and Functional Dependence in Maintenance Hemodialysis.Nutrients · 2026Article
- Hypocalcemia in Dialysis Is Not Associated with Increased Mortality: Evidence from a Population-Based Cohort.Nutrients · 2026Article
- Practice patterns on the management of secondary hyperparathyroidism in the United States: Results from a modified Delphi panel.PloS one · 2025Article
- Association between blood phosphorus level and adverse outcomes in patients with coronary artery disease: A meta-analysis.Heliyon · 2024Article
- Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy.Clinical medicine (London, England) · 2024Review
- Skeletal Muscle Injury in Chronic Kidney Disease-From Histologic Changes to Molecular Mechanisms and to Novel Therapies.International journal of molecular sciences · 2024Review
- Semaglutide and Patients Receiving Hemodialysis: Case Reports of Unexpected Benefits for Hyperphosphatemia and Hyperkalemia.The Canadian journal of hospital pharmacy · 2024Article
- Association between Serum Inorganic Phosphorus Levels and Adverse Outcomes in Chronic Kidney Disease: The Fukushima CKD Cohort Study.Internal medicine (Tokyo, Japan) · 2022Article
- The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients.Renal failure · 2021Article
- The Association between Changes in Low Parathyroid Hormone Levels and Cardiac Function Decline in Maintenance Hemodialysis Patients: A Prospective Observational Study.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2021Observational
- The risk of medically uncontrolled secondary hyperparathyroidism depends on parathyroid hormone levels at haemodialysis initiation.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2021Article
- Article
- Joint Longitudinal Low Calcium High Phosphorus Trajectory Associates with Accelerated Progression, Acute Coronary Syndrome and Mortality in Chronic Kidney Disease.Scientific reports · 2020Article
- The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients.BMC nephrology · 2019Article
- Application of dynamic optimisation for planning a haemodialysis process.BMC nephrology · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBiochemical markers of altered mineral metabolism have been associated with increased mortality in end stage renal disease patients. Several studies have demonstrated non-linear (U-shaped or J-shaped) associations between these minerals and mortality, though many researchers have assumed linear relationships in their statistical modeling. This analysis synthesizes the non-linear relationships across studies.
methodsWe updated a prior systematic review through 2010. Studies included adults receiving dialysis and reported categorical data for calcium, phosphorus, and/or parathyroid hormone (PTH) together with all-cause mortality. We performed 2 separate meta-analyses to compare higher-than-referent levels vs referent and lower-than-referent levels vs referent levels.
resultsA literature review showed that when a linear relationship between the minerals and mortality was assumed, the estimated associations were more likely to be smaller or non-significant compared to non-linear models. In the meta-analyses, higher-than-referent levels of phosphorus (4 studies, RR = 1.20, 95% CI = 1.15-1.25), calcium (3 studies, RR = 1.10, 95% CI = 1.05-1.14), and PTH (5 studies, RR = 1.11, 95% CI = 1.07-1.16) were significantly associated with increased mortality. Although no significant associations between relatively low phosphorus or PTH and mortality were observed, a protective effect was observed for lower-than-referent calcium (RR = 0.86, 95% CI = 0.83-0.89).
conclusionsHigher-than-referent levels of PTH, calcium, and phosphorus in dialysis patients were associated with increased mortality risk in a selection of observational studies suitable for meta-analysis of non-linear relationships. Findings were less consistent for lower-than-referent values. Future analyses should incorporate the non-linear relationships between the minerals and mortality to obtain accurate effect estimates.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.