Fernández-Martín, JLMartínez-Camblor, PDionisi, MPFloege, JKetteler, MLondon, GLocatelli, FGorriz, JLRutkowski, BFerreira, ABos, WJCovic, ARodríguez-García, MSánchez, JERodríguez-Puyol, DCannata-Andia, JB2016-06-172016-06-172015-09Nephrol Dial Transplant. 2015 Sep;30(9):1542-51http://hdl.handle.net/10400.17/2515BACKGROUND: Abnormalities in serum phosphorus, calcium and parathyroid hormone (PTH) have been associated with poor survival in haemodialysis patients. This COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis assesses the association of high and low serum phosphorus, calcium and PTH with a relative risk of mortality. Furthermore, the impact of changes in these parameters on the relative risk of mortality throughout the 3-year follow-up has been investigated. METHODS:COSMOS is a 3-year, multicentre, open-cohort, prospective study carried out in 6797 adult chronic haemodialysis patients randomly selected from 20 European countries. RESULTS:Using Cox proportional hazard regression models and penalized splines analysis, it was found that both high and low serum phosphorus, calcium and PTH were associated with a higher risk of mortality. The serum values associated with the minimum relative risk of mortality were 4.4 mg/dL for serum phosphorus, 8.8 mg/dL for serum calcium and 398 pg/mL for serum PTH. The lowest mortality risk ranges obtained using as base the previous values were 3.6-5.2 mg/dL for serum phosphorus, 7.9-9.5 mg/dL for serum calcium and 168-674 pg/mL for serum PTH. Decreases in serum phosphorus and calcium and increases in serum PTH in patients with baseline values of >5.2 mg/dL (phosphorus), >9.5 mg/dL (calcium) and <168 pg/mL (PTH), respectively, were associated with improved survival. CONCLUSIONS:COSMOS provides evidence of the association of serum phosphorus, calcium and PTH and mortality, and suggests survival benefits of controlling chronic kidney disease-mineral and bone disorder biochemical parameters in CKD5D patients.engAdultBiomarkers/bloodBone and Bones/metabolismCalcium/bloodEurope/epidemiologyFemaleFollow-Up StudiesHumansHyperparathyroidism, Secondary/bloodMaleMiddle AgedParathyroid Hormone/bloodPhosphorus/bloodPrognosisProportional Hazards ModelsProspective StudiesRenal Dialysis/mortalityRenal Insufficiency, Chronic/therapySurvival RateHCC NEFHyperparathyroidism, Secondary/mortalityjournal article10.1093/ndt/gfv099