Chronic Kidney Disease

CKD/Bone Disorder Composite Score Could Predict Outcomes

A composite score including calcium (Ca), phosphorus (P) and parathyroid hormone (PTH) could help to identify patients with chronic kidney disease–mineral and bone disorder (CKD-MBD) receiving hemodialysis who are at increased risk of clinical outcomes, according to the results of a recent study.

In order to further investigate the potential of a CKD-MBD score, the researchers conducted a study of 19,313 patients from the Dialysis Outcomes and Practice Patterns Study Phases 3 through 5 residing in Europe, Canada, and the United States. The composite score was defined as how many markers fell above target levels (P, 3.5–5.5 mg/dL; Ca, 8.4–10.2 mg/dL; PTH, 150–600 pg/mL).

Overall, 10% to 14% of patients across the study regions had 2 to 3 MBD scores above target, which was associated with a greater risk of disease risk score-adjusted mortality (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.10–1.82) and greater risk of composite events (HR 1.23 (95% CI 1.10–1.38) in US patients compared with individuals with 0 MBD scores above target. Risk observed in Canadian and European patients were similar, but lower than those observed in US patients.

“In summary, this analysis of international Dialysis Outcomes and Practice Patterns Study data supports prior work highlighting the association of the CKD-MBD composite score and clinical outcomes in US hemodialysis patients. Consistent but weaker associations were observed in Europe and Canada. Our findings suggest that simultaneous consideration of MBD parameters in the management of CKD-MBD may help with identifying patients with a higher risk of adverse outcomes and who may benefit from more directed therapeutic intervention,” the researchers concluded.

—Michael Potts


Fuller DS, Dluzniewski PJ, Cooper K, et al. Combinations of mineral and bone disorder markers and risk of death and hospitalizations in the international Dialysis Outcomes and Practice Patterns Study. CKJ. 2020;13(6):1056–1062.