To the Editor: Dr Palmer and colleagues found in a meta-analysis1 that high serum levels of phosphorus were associated with an increased risk for all-cause mortality in patients with chronic kidney disease; however, there was no strong or consistent relationship between serum calcium or parathyroid hormone levels and all-cause mortality. Evidence supports the control of secondary hyperparathyroidism in chronic kidney disease,2 but much controversy exists regarding whether parathyroid hormone levels are associated with an increased risk of mortality. Some methodological considerations affect the conclusions drawn by the authors of the meta-analysis.
Floege J, Kronenberg F, Froissart M. Mortality in Chronic Kidney Disease and Mineral Metabolism. JAMA. 2011;306(2):159-160. doi:10.1001/jama.2011.948