Abstract
BackgroundAchieving target levels of laboratory parameters of bone and mineral metabolism in chronic kidney disease (CKD) patients is important but also difficult in those living with end-stage kidney disease. This study aimed to determine if there are age-related differences in chronic kidney disease-mineral and bone disorder (CKD-MBD) characteristics, including treatment practice in Hungarian dialysis patients.MethodsData were collected retrospectively from a large cohort of dialysis patients in Hungary. Patients on hemodialysis and peritoneal dialysis were also included. The enrolled patients were allocated into two groups based on their age (<65 years and ≥65 years). Characteristics of the age groups and differences in disease-related (epidemiology, laboratory, and treatment practice) parameters between the groups were analyzed.ResultsA total of 5008 patients were included in the analysis and the mean age was 63.4±14.2 years. A total of 47.2% of patients were women, 32.8% had diabetes, and 11.4% were on peritoneal dialysis. Diabetes (37.9% vs 27.3%), bone disease (42.9% vs 34.1%), and soft tissue calcification (56.3% vs 44.7%) were more prevalent in the older group than the younger group (p<0.001 for all). We found an inverse relationship between age and parathyroid hormone (PTH) levels (p<0.001). Serum PTH levels were lower in patients with diabetes compared with those without diabetes below 80 years (p<0.001). Diabetes and age were independently associated with serum PTH levels (interaction: diabetes × age groups, p=0.138). Older patients were more likely than younger patients to achieve laboratory target ranges for each parameter (Ca: 66.9% vs 62.1%, p<0.001; PO4: 52.6% vs 49.2%, p<0.05; and PTH: 50.6% vs 46.6%, p<0.01), and for combined parameters (19.8% vs 15.8%, p<0.001). Older patients were less likely to receive related medication than younger patients (66.9% vs 79.7%, p<0.001).ConclusionsThe achievement of laboratory target ranges for bone and mineral metabolism and clinical practice in CKD depends on the age of the patients. A greater proportion of older patients met target criteria and received less medication compared with younger patients.
Highlights
Achieving target levels of laboratory parameters of bone and mineral metabolism in chronic kidney disease (CKD) patients is important and difficult in those living with end-stage kidney disease
Patients who received treatment were slightly less likely to fall in the target range for Ca (64.9% vs 69.0%, p
Our survey did not capture possible important confounding variables, such as dialysis vintage, co-morbidities, residual renal function, and dialysis adequacy, which could have influenced the examined associations. This nationwide survey provides important information about our patient population and it is able to show directions to further improve the quality of dialysis care. In summary, this was the first survey in Hungary in which almost all patients on maintenance HD or peritoneal dialysis (PD) were enrolled to analyze patient characteristics and treatment practices related to chronic kidney disease-mineral and bone disorder (CKD-MBD)
Summary
Achieving target levels of laboratory parameters of bone and mineral metabolism in chronic kidney disease (CKD) patients is important and difficult in those living with end-stage kidney disease. This study aimed to determine if there are age-related differences in chronic kidney disease-mineral and bone disorder (CKD-MBD) characteristics, including treatment practice in Hungarian dialysis patients. The prevalence of chronic kidney disease (CKD), and dialysis therapy and appearance of comorbidities, is continuously increasing in the developed world because of the high prevalence of well known risk factors and aging of the population. There is a considerable amount of patients with laboratory parameters concurrently outside the normal target ranges, which further aggravates the risk of morbidity and mortality [3,4,5,6]. The lack of related evidence-based data contributes to continuous changes in clinical guidelines [8,9,10,11,12,13,14]
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