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In this 9-year cohort study, we investigated the associations between the changes in calcium\/phosphate levels and all-cause mortality using a time-dependent approach after adjustment for potential confounders in groups stratified by performance status (PS), a history of atherosclerotic cardiovascular disease (ACVD), or diabetic nephropathy (DN). In patients with baseline serum calcium levels of 9.5\u2013&lt;10.0\u00a0mg\/dL, increases in serum calcium levels were associated with higher mortality exclusively in patients with PS Grade 0. In the same baseline calcium range, a significant association was observed between reduced serum calcium levels and lower mortality only in patients with a history of ACVD or DN. Similarly, in patients with baseline serum phosphate levels of 5.0\u2013&lt;5.5\u00a0mg\/dL, reduced serum phosphate levels were associated with lower mortality only in those with PS Grade 0, a history of ACVD or DN. These findings indicate that PS should be considered in treating mild hypercalcemia or hyperphosphatemia in hemodialysis patients. Moreover, stringent management of hypercalcemia and hyperphosphatemia in patients with a history of ACVD or DN might be associated with a better prognosis.<\/jats:p>","DOI":"10.1038\/s41598-025-92359-0","type":"journal-article","created":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T07:48:06Z","timestamp":1741420086000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient characteristics modify the association between changes in mineral metabolism parameters and mortality in a nationwide hemodialysis cohort study"],"prefix":"10.1038","volume":"15","author":[{"given":"Shunsuke","family":"Goto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Hamano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatomo","family":"Taniguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Abe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosaku","family":"Nitta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Nishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Fujii","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,8]]},"reference":[{"key":"92359_CR1","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1111\/1744-9987.12030","volume":"17","author":"M Taniguchi","year":"2013","unstructured":"Taniguchi, M. et al. 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G. reports receiving honoraria from Kyowa Kirin, Sanwa Kagaku Kenkyusho, Kissei, Astellas, and Ono and scholarship grants from Kyowa Kirin and Chugai. T. H. reports receiving honoraria from Kyowa Kirin, Ono, Sanwa Kagaku Kenkyusho, Kissei, Astellas, Chugai, and Torii and research funding from Kyowa Kirin, Kissei, Chugai, Sanwa Kagaku Kenkyusho, and Torii. M. T. reports receiving honoraria from Kyowa Kirin, Torii, Kissei, Ono, Bayer, Daiichi Sankyo, Sanwa Kagaku Kenkyusho, Astellas, and Mitsubishi Tanabe. M. A. reports receiving research funding from Kyowa Kirin and Torii. K. N. reports receiving honoraria from Kyowa Kirin and receiving research funding from Kyowa Kirin. S. N. reports receiving honoraria from Kyowa Kirin, Chugai, Bayer Yakuhin, Kissei, Astellas, and Torii, and receiving scholarship grants from Kyowa Kirin and Chugai. H. F. reports receiving speaker fees as honoraria from Kyowa Kirin, Bayer, Kissei, and Astellas and scholarship grants from Kyowa Kirin and Chugai.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8089"}}