#2063 Association between CKD–MBD and mortality, cardiovascular events, and fractures in peritoneal dialysis patients

Abstract Background and Aims This observational study aimed to investigate the association between changes in chronic kidney disease-mineral and bone disorder (CKD-MBD)parameters and clinical outcomes in patients undergoing peritoneal dialysis (PD). It is well-established that abnormalities in CKD–MBD parameters are associated with an increased risk of adverse outcomes, including mortality, in hemodialysis patients. However, there is limited evidence regarding the relationship between CKD–MBD parameters and clinical outcomes such as mortality, cardiovascular events, and fractures in PD patients. This study aims to fill this gap by investigating the association of CKD–MBD parameters with these outcomes in PD patients. Method We included 63 patients who started PD at our facility between April 2017 and March 2022. The study examined the mean values of corrected calcium (Ca), phosphate (P), and intact parathyroid hormone (iPTH) during the first year from dialysis initiation, measured every three months. Cox proportional hazards models were employed to analyze the relationship between these CKD-MBD parameters and mortality, cardiovascular risk, and fracture risk. Results The study included 63 patients, with a mean age of 71 ± 17 years, and 44 males (69.8%). The mean observation period was 31 ± 15 months. The mean values of corrected Ca, P, and iPTH were 9.1 ± 0.4 mg/dL, 5.1 ± 0.9 mg/dL, and 258 ± 130 pg/mL, respectively. During the follow-up, 25 patients died, 16 experienced cardiovascular events, and 8 had fractures. In the analysis of cardiovascular events, the group with corrected Ca ≥9.5 mg/dL had a higher risk of cardiovascular events compared to the group with 9.0 ≤ corrected Ca < 9.5 mg/dL (hazard ratio 7.51, 95% CI 1.7–32.6, P = 0.007). Additionally, the group with P ≥ 5.5 mg/dL had a higher risk of cardiovascular events compared to the group with 4.5 ≤ P < 5.5 mg/dL (hazard ratio 4.71, 95% CI 1.1–19.8, P = 0.035). No significant associations were found between CKD-MBD parameters and mortality or fracture risk. Conclusion In PD patients, higher corrected Ca and P levels were associated with an increased risk of cardiovascular events, but no significant associations were found with mortality or fracture risk. These findings suggest that managing Ca and P levels may be crucial for reducing cardiovascular risk in this population.