| Abstract | BACKGROUND: After application of K/DOQI recommendations, a large proportion of our patients failed to reach the proposed targets. This study examined the causes of these findings. METHODS: Patients (n=163) were compared in 2 periods (8 months before and after application of K/DOQI guidelines). Serum calcium (Ca), phosphorus (P), parathyroid hormone (PTH) and calcium x phosphate product (Ca x P); mean dialysate Ca content; mean doses of vitamin D; and average prescription of Ca-based phosphate binders and sevelamer in both periods were analyzed. RESULTS: Prescription of Ca salts as phosphate-binding agents decreased and prescription of sevelamer increased in an attempt to maintain serum Ca levels between 8.4 and 9.5 mg/dL post-K/DOQI. Increased serum PTH levels were associated with decreased serum Ca levels (relative risk [RR] = 41.1, p<0.001) and increased serum P levels (RR=6.81, p<0.01). Use of dialysis fluids with Ca content of 2.5 mEq/L was associated with an increased risk of having PTH levels >300 pg/mL (RR=11.4, p<0.003). Vitamin D metabolites had to be discontinued in 26 patients (37.1% of those receiving them from study start) due to hyperphosphoremia or hypercalcemia post-K/DOQI; and serum PTH significantly increased (445.8 +/- 238.2 pg/mL vs. 715.2 +/- 549.5 pg/mL; p<0.001). Ninety-three patients (57%) did not receive vitamin D at study start; in 20 of those (21.5%), vitamin D had to be started post-K/DOQI. CONCLUSIONS: Clinical guidelines do not appear to be sufficient to overcome all difficulties arising in daily management of these patients. |
| Authors | María D Arenas, Fernando Alvarez-Ude, Vicente Torregrosa, María T Gil, María A Carretón, Analía Moledous, Carlos Nuñez, Ramón Devesa, Begoña Albiach
(Affiliation: Department of Nephrology, Perpetuo Socorro Hospital, Alicante, Spain. arenasd at perpetuosocorro.nehos.com)
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| Journal | Journal of nephrology
(J Nephrol)
2007 Jul-Aug
Vol. 20
Issue 4
Pg. 453-61
ISSN: 1121-8428 Italy |
| PMID | 17879212
(Publication Type: Journal Article)
|
| Chemical References |
- Chelating Agents
- PTH protein, human
- Parathyroid Hormone
- Polyamines
- Vitamin D
- sevelamer
- Calcium
- Phosphorus
|
| Topics |
- Aged
- Bone and Bones
(metabolism)
- Calcium
(blood)
- Chelating Agents
(administration & dosage)
- Female
- Humans
- Kidney Failure, Chronic
(complications, therapy)
- Male
- Middle Aged
- Parathyroid Hormone
(blood)
- Phosphorus
(blood)
- Polyamines
(administration & dosage)
- Practice Guidelines as Topic
- Renal Dialysis
- Renal Osteodystrophy
(diagnosis, drug therapy, etiology)
- Retrospective Studies
- Vitamin D
(administration & dosage)
|
