Background: Secondary hyperparathyroidism, malnutrition and inflammation have been reported to associate with adverse outcomes in dialysis patients. However, little is known about the implications of these conditions for treatment costs. Methods: The cost data of all adult patients who had entered dialysis therapy at Tampere University Hospital between 1991 and 1996 and had remained on dialysis for at least 1 year were collected. Results of measurements of parathyroid hormone (PTH), calcium, phosphorus, albumin and C-reactive protein (CRP) were obtained from the database of the hospital. Results: Patients (n = 109), aged 57.0 ± 14.9 years, included 57% men and 37% diabetics; 62% started on hemodialysis and 38% on peritoneal dialysis. Average daily costs were USD 161 (range 95–360). After controlling for patients’ age, body mass index, gender, dialysis modality and primary renal disease, there was a positive correlation between average CRP and average costs and a negative correlation between albumin and costs. Correlations between mineral metabolism markers and costs were not found, but there was a trend towards lower cost among patients who achieved the Kidney Disease Outcomes Quality Initiative targets of calcium, phosphorus and PTH (USD 145 ± 31) compared with those with nonoptimal levels (USD 165 ± 48; p = 0.095). Costs of patients with at least one in-target PTH measurement were lower than costs of patients with constantly low PTH (USD 148 ± 31 vs. 170 ± 48; p = 0.01). Conclusion: Serum levels of albumin and CRP correlated with dialysis patients’ treatment costs. Achieving the Kidney Disease Outcomes Quality Initiative targets may be associated with lower costs.

Keywords:
Albumin, C-reactive protein, Maintenance dialysis costs, Mineral metabolism
1.
Slatopolsky E, Brown A, Dusso A: Pathogenesis of secondary hyperparathyroidism. Kidney Int 1999;56:S14–S19.
2.
Kalantar-Zadeh K, Kopple J, Humphreys M, Block G: Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004;19:1507–1519.
3.
Locatelli F: The need for better control of secondary hyperparathyroidism. Nephrol Dial Transplant 2004;19:S15–S19.
4.
Lowrie E, Lew N: Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458–482.
5.
Ganesh S, Stack A, Levin N, Hulbert-Shearon T, Port F: Association of elevated serum PO(4), Ca × PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001;12:2131–2138.
6.
Marco M, Craver L, Betriu A, et al: Higher impact of mineral metabolism on cardiovascular mortality in a European hemodialysis population. Kidney Int 2003;85:S111–S114.
7.
Block G, Hulbert-Shearon T, Levin N, Port F: Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998;31:607–617.
8.
Hruska K, Teitelbaum S: Renal osteodystrophy. N Engl J Med 1995;333:166–174.
9.
Danese M, Kim J, Doan Q, et al: PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis 2006;47:149–156.
10.
Locatelli F, Cannata-Andia J, Drueke T, et al: Management of disturbances of calcium and phosphate metabolism in chronic renal insufficiency, with emphasis on the control of hyperphosphataemia. Nephrol Dial Transplant 2002;17:723–731.
11.
National Kidney Foundation: K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42:S1–S201.
12.
Young E, Satayathum S, Pisoni R, et al: Prevalence of values on mineral metabolism being outside the targets from the proposed new draft NKF-K/DOQI and European Best Practice guidelines in countries of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2003;18(suppl 4):677.
13.
Stenvinkel P, Heimburger O, Lindholm B, Kaysen G, Bergstrom J: Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000;15:953–960.
14.
Kalantar-Zadeh K, Ikizler T, Block G, Avram M, Kopple J: Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 2003;42:864–881.
15.
Kaysen G: Biological basis of hypoalbuminemia in ESRD. J Am Soc Nephrol 1998;9:2368–2376.
16.
Salonen T, Reina T, Oksa H, Sintonen H, Pasternack A: Cost analysis of renal replacement therapies in Finland. Am J Kidney Dis 2003;42:1228–1238.
17.
Block G, Klassen P, Lazarus J, et al: Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004;15:2208–2218.
18.
London G, Guerin A, Marchais S, et al: Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003;18:1731–1740.
19.
Cunningham J, Danese M, Olson K, Klassen P, Chertow G: Effects of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 2005;68:1793–1800.
© 2007 S. Karger AG, Basel
2007
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.