Evidence map›Paper›PMID 27045726›Full record

ArticleThe Journal of clinical endocrinology and metabolism2016

Hidden Hypercalcemia and Mortality Risk in Incident Hemodialysis Patients.

Yoshitsugu Obi, Rajnish Mehrotra, Matthew B Rivara, Elani Streja, Connie M Rhee, Wei Ling Lau, Csaba P Kovesdy, Kamyar Kalantar-Zadeh

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of clinical endocrinology and metabolism, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
2.3field-weighted citation impact, top 13% of its field
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

17 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Clinical impact of ionized calcium and hidden hypocalcemia on cardiovascular outcomes in dialysis patients.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026
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  12. Observational
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  17. Development and Validation of a Novel Laboratory-Specific Correction Equation for Total Serum Calcium and Its Association With Mortality Among Hemodialysis Patients.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2017
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Yoshitsugu ObiDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Rajnish MehrotraDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Matthew B RivaraDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Elani StrejaDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Connie M RheeDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Wei Ling LauDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Csaba P KovesdyDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
Kamyar Kalantar-ZadehDivision of Nephrology and Hypertension (Y.O., E.S., C.M.R., W.L.L., K.K.-Z.), Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California 92868; Division of Nephrology (R.M., M.B.R.), Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38103; Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104; Fielding School of Public Health at University of California at Los Angeles (K.K.-Z.), Los Angeles, California 90024; and Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (K.K.-Z.), Torrance, California 90502.
University of California, Irvine · USHarborview Medical Center · USUniversity of Tennessee Health Science Center · US

Funding

University of California Health Participation in the National COVID Cohort Collaborative (N3C)UL1TR001414 · NCATS · UNIVERSITY OF CALIFORNIA-IRVINE · PI COOPER, DAN M, VILAIN, ERIC J. · 2015 to 2023
$35.1M
Transition of Care in CKD (TC-CKD)U01DK102163 · NIDDK · UNIVERSITY OF CALIFORNIA-IRVINE · PI JACOBSEN, STEVEN J, KALANTAR-ZADEH, KAMYAR · 2014 to 2018
$2.8M
MALNUTRITION, DIET AND RACIAL DISPARITIES IN CKDK24DK091419 · NIDDK · UNIVERSITY OF CALIFORNIA-IRVINE · PI KALANTAR-ZADEH, KAMYAR · 2011 to 2020
$1.8M
Examining Racial and Cardiovascular Paradoxes in Chronic Kidney DiseaseR01DK078106 · NIDDK · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI KALANTAR-ZADEH, KAMYAR · 2007 to 2011
$1.1M
Comparative Effectiveness of Dialysis ModalitiesR01DK095668 · NIDDK · UNIVERSITY OF WASHINGTON · PI KALANTAR-ZADEH, KAMYAR, MEHROTRA, RAJNISH · 2012 to 2014
$1.0M
Hypothyroidism, Cardiovascular Health, and Survival in Kidney DiseaseK23DK102903 · NIDDK · UNIVERSITY OF CALIFORNIA-IRVINE · PI RHEE, CONNIE MEEYOUNG · 2014 to 2018
$955k
Racial and Cardiovascular Risk Factor Anomalies in CKDR01DK096920 · NIDDK · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · PI KALANTAR-ZADEH, KAMYAR, KOVESDY, CSABA PAL · 2013 to 2015
$909k
NCATS NIH HHS UL1 TR001414NIDDK NIH HHS K23 DK102903NIDDK NIH HHS K24 DK091419NIDDK NIH HHS R01 DK078106NIDDK NIH HHS R01 DK095668NIDDK NIH HHS R01 DK096920NIDDK NIH HHS U01 DK102163
6 · The paper itself

Abstract

contextNeither uncorrected- nor albumin-corrected total calcium reliably predict ionized calcium in patients with end-stage renal disease. However, little is known about the consequences of inaccurate assessment of calcium concentration using total calcium.

objectiveWe hypothesized that hidden hypercalcemia (ie, elevated ionized calcium with normal total calcium) and apparent hypercalcemia (ie, elevated ionized calcium with elevated total calcium) are both associated with increased mortality risk. DESIGN, SETTING, AND PATIENTS: We identified 874 incident hemodialysis patients with measured serum ionized calcium, total calcium, albumin, phosphorus, and bicarbonate from October 2007 to December 2011, using data from a large dialysis organization in the United States. EXPOSURES: Serum concentrations of ionized calcium and total calcium were measured.

main outcome measureThe primary outcome was all-cause mortality.

resultsThere was only fair interindex agreement with calcium status between ionized calcium and uncorrected or corrected total calcium (κ = 0.32 and 0.27, respectively). Among patients with high ionized calcium (>1.32 mmol/liter), 88% and 70% patients were incorrectly categorized as being normocalcemic using uncorrected and corrected total calcium, respectively, and were thus considered to have "hidden hypercalcemia." Compared to patients with low-normal ionized calcium (1.16-1.24 mmol/liter), patients with high ionized calcium had a significantly higher mortality risk (adjusted hazard ratio, 1.77; 95% confidence interval, 1.13-2.75). Furthermore, compared to patients with normocalcemia (ionized calcium 1.16-1.32 mmol/liter), those with hidden hypercalcemia by uncorrected and corrected total calcium also had a higher risk for death (adjusted hazard ratio 1.75 [95% confidence interval 1.11-2.75] and 1.80 [95% confidence interval, 1.11-2.90], respectively).

conclusionThe majority of end-stage renal disease patients with elevated ionized calcium are incorrectly categorized as normocalcemic using conventional total calcium measurements; these patients have a higher death risk. Future research is needed to establish whether reducing ionized calcium concentrations in these patients improves clinical outcomes.

Indexed as

AgedFemaleHumansHypercalcemiaKidney Failure, ChronicMaleMiddle AgedRenal DialysisRisk FactorsSurvival Rate

Identifiers

PMID27045726
PMCPMC4891800
OpenAlexW2328225070

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.