{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:59:18Z","timestamp":1792277958618,"version":"4.4.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T00:00:00Z","timestamp":1696032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Calcimimetics are widely used in hemodialysis patients and influence serum calcium levels. Although the Kidney Disease: Improving Global Outcomes guidelines argued that low calcium levels induced by calcimimetics may be harmless, large observational studies investigating the association between hypocalcemia and mortality are scarce. We investigated the association between serum calcium levels and cardiovascular mortality in calcimimetics users using the nationwide Japanese registry for dialysis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this 9-year prospective cohort study, the baseline data were collected at the end of 2009. We enrolled patients on maintenance hemodialysis or hemodiafiltration. We employed three models (baseline, time-dependent and time-averaged) to conduct Cox proportional hazard regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cinacalcet was prescribed to 12.7% (N\u00a0=\u00a022\u00a0853) at baseline. The median observation period was 98 (interquartile range 40\u2013108) months and 108 (interquartile range 59\u2013108) months in the whole cohort (N\u00a0=\u00a0180\u00a0136) and in cinacalcet users, respectively. Three-quarters of survivors at the end of 2019 had continued calcimimetic therapy for 10\u00a0years, corresponding to a mean annual dropout rate of 2.9%. Hypocalcemia was not associated with cardiovascular mortality in the baseline or time-averaged model. In the time-dependent model, however, the lowest calcium decile (corrected calcium &amp;lt;8.4\u00a0mg\/dL) was significantly associated with higher cardiovascular mortality than the reference (corrected calcium 8.7\u20138.9\u00a0mg\/dL) in both cinacalcet users and all patients [hazard ratio (95% confidence interval) 1.32 (1.00, 1.75) and 1.15 (1.05, 1.26), respectively]. Hypocalcemia was especially associated with sudden death and death due to hemorrhagic stroke, heart failure and ischemic heart disease. Higher rate of fatal and non-fatal cardiovascular events was observed in hypocalcemic patients regardless of cinacalcet usage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that transient hypocalcemia was associated with an increased risk of cardiovascular death independent of cinacalcet usage. We should pay attention to hypocalcemia transiently induced by cinacalcet.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfad213","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T08:26:16Z","timestamp":1695975976000},"page":"637-647","source":"Crossref","is-referenced-by-count":34,"title":["Hypocalcemia and cardiovascular mortality in cinacalcet users"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7102-2843","authenticated-orcid":false,"given":"Shunsuke","family":"Goto","sequence":"first","affiliation":[{"name":"Committee of Renal Data Registry, Japanese Society for Dialysis Therapy , Tokyo , Japan"},{"name":"Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine , Kobe , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Hamano","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Nagoya City University, Graduate School of Medical Sciences , Nagoya , Japan"},{"name":"Department of Nephrology, Osaka University Graduate School of Medicine , Suita , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7610-1068","authenticated-orcid":false,"given":"Hideki","family":"Fujii","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine , Kobe , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatomo","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Committee of Renal Data Registry, Japanese Society for Dialysis Therapy , Tokyo , Japan"},{"name":"Fukuoka Renal Clinic , Fukuoka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Abe","sequence":"additional","affiliation":[{"name":"Committee of Renal Data Registry, Japanese Society for Dialysis Therapy , Tokyo , Japan"},{"name":"Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosaku","family":"Nitta","sequence":"additional","affiliation":[{"name":"Committee of Renal Data Registry, Japanese Society for Dialysis Therapy , Tokyo , Japan"},{"name":"Department of Medicine, Kidney Center, Tokyo Women's Medical University , Tokyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Nishi","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine , Kobe , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,30]]},"reference":[{"key":"2024032707113728000_bib1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/1744-9987.12030","article-title":"Serum phosphate and calcium should be primarily and consistently controlled in prevalent hemodialysis patients","volume":"17","author":"Taniguchi","year":"2013","journal-title":"Ther Apher Dial"},{"key":"2024032707113728000_bib2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/j.1744-9987.2007.00540.x","article-title":"Effects of serum calcium, phosphorous, and intact parathyroid hormone levels on survival in chronic hemodialysis patients in Japan","volume":"12","author":"Nakai","year":"2008","journal-title":"Ther Apher Dial"},{"key":"2024032707113728000_bib3","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1093\/ndt\/gfv099","article-title":"Improvement of mineral and bone metabolism markers is associated with better survival in hemodialysis patients: the COSMOS study","volume":"30","author":"Fern\u00e1ndez-Mart\u00edn","year":"2015","journal-title":"Nephrol Dial Transplant"},{"key":"2024032707113728000_bib4","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/1471-2369-14-88","article-title":"Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? 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