Evidence map›Paper›PMID 25516917›Full record

Observational studyClinical journal of the American Society of Nephrology : CJASN2015

Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study.

Francesca Tentori, Mia Wang, Brian A Bieber, Angelo Karaboyas, Yun Li, Stefan H Jacobson, Vittorio E Andreucci, Masafumi Fukagawa, Luc Frimat, David C Mendelssohn and 3 more

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Clinical journal of the American Society of Nephrology : CJASN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 146 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
146citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

146 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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86 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Francesca TentoriArbor Research Collaborative for Health, Ann Arbor, Michigan; Vanderbilt University Medical Center, Nashville, Tennessee francesca.tentori@ArborResearch.org.
Mia WangArbor Research Collaborative for Health, Ann Arbor, Michigan;
Brian A BieberArbor Research Collaborative for Health, Ann Arbor, Michigan;
Angelo KaraboyasArbor Research Collaborative for Health, Ann Arbor, Michigan;
Yun LiArbor Research Collaborative for Health, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan;
Stefan H JacobsonDepartment of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden;
Vittorio E AndreucciUniversity of Naples Federico II, Naples, Italy;
Masafumi FukagawaDivision of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan;
Luc FrimatClinical Epidemiology, Inserm CIC-EC and Nephrology Department, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-lès-Nancy, France;
David C MendelssohnDepartment of Nephrology, Humber River Regional Hospital and University of Toronto, Weston, Ontario, Canada; and.
Friedrich K PortArbor Research Collaborative for Health, Ann Arbor, Michigan;
Ronald L PisoniArbor Research Collaborative for Health, Ann Arbor, Michigan;
Bruce M RobinsonArbor Research Collaborative for Health, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

Funding

Quality Dialysis Outcomes & Practice Patterns Study (DOPPS) in hemodialysisK01DK087762 · NIDDK · ARBOR RESEARCH COLLABORATIVE FOR HEALTH · PI TENTORI, FRANCESCA · 2011 to 2015
$744k
NIDDK NIH HHS K01 DK087762NIDDK NIH HHS K01DK087762
6 · The paper itself

Abstract

BACKGROUND AND

objectivesElevated parathyroid hormone levels may be associated with adverse clinical outcomes in patients on dialysis. After the introduction of practice guidelines suggesting higher parathyroid hormone targets than those previously recommended, changes in parathyroid hormone levels and treatment regimens over time have not been well documented. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using data from the international Dialysis Outcomes and Practice Patterns Study, trends in parathyroid hormone levels and secondary hyperparathyroidism therapies over the past 15 years and the associations between parathyroid hormone and clinical outcomes are reported; 35,655 participants from the Dialysis Outcomes and Practice Patterns Study phases 1-4 (1996-2011) were included.

resultsMedian parathyroid hormone increased from phase 1 to phase 4 in all regions except for Japan, where it remained stable. Prescriptions of intravenous vitamin D analogs and cinacalcet increased and parathyroidectomy rates decreased in all regions over time. Compared with 150-300 pg/ml, in adjusted models, all-cause mortality risk was higher for parathyroid hormone=301-450 (hazard ratio, 1.09; 95% confidence interval, 1.01 to 1.18) and >600 pg/ml (hazard ratio, 1.23; 95% confidence interval, 1.12 to 1.34). Parathyroid hormone >600 pg/ml was also associated with higher risk of cardiovascular mortality as well as all-cause and cardiovascular hospitalizations. In a subgroup analysis of 5387 patients not receiving vitamin D analogs or cinacalcet and with no prior parathyroidectomy, very low parathyroid hormone (<50 pg/ml) was associated with mortality (hazard ratio, 1.25; 95% confidence interval, 1.04 to 1.51).

conclusionsIn a large international sample of patients on hemodialysis, parathyroid hormone levels increased in most countries, and secondary hyperparathyroidism treatments changed over time. Very low and very high parathyroid hormone levels were associated with adverse outcomes. In the absence of definitive evidence in support of a specific parathyroid hormone target, there is an urgent need for additional research to inform clinical practice.

Indexed as

Dietary SupplementsAdultAgedBiomarkersCalcimimetic AgentsCinacalcetFemaleHumansHyperparathyroidism, SecondaryMaleMiddle AgedNaphthalenesParathyroidectomyParathyroid HormoneProspective StudiesRenal DialysisBiomarkersCalcimimetic AgentsCinacalcetNaphthalenesParathyroid HormonePTH protein, humanVitamin DCKDdialysisESRDhyperparathyroidismparathyroid hormone

Identifiers

PMID25516917
PMCPMC4284424

What OpenQuestion holds

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Registered trials

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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.