Comment atteindre et maintenir les recommandations K/DOQI TM sur le métabolisme phosphocalcique chez les patients dialysés : une stratégie efficace

Abstract

Introduction Recent publications have indicated that alterations in bone and mineral metabolism are known to participate to a high mortality rate in patients undergoing haemodialysis. A new therapeutic strategy is progressively undertaken in the dialysis unit over a 36 months period covering years 2002 to 2004. Methods This new strategy includes the prescription of non-calcium, non-aluminium phosphate binder, sevelamer hydrochloride, an increase in vitamin D analogues prescription and a moderation in calcium carbonate administration. Sixty patients participated to the entire study and are evaluated three times a year on the four K/DOQI TM parameters. Other indicators such as haemoglobin, bicarbonate, total cholesterol and HDL cholesterol levels were studied. Results At the beginning of the study, 7% of the patients achieved the four K/DOQI TM parameters. This proportion seemed identical to those observed in the major studies. But progressively with the new therapeutic strategy 13%, then 21%, and at the end of the study 35% reached the four criteria. Therapeutic calcium intakes decreased from 100 g per patient/month to 28 g per patient-month. Prescription of vitamin D analogues increased from 3,3 μg per patient-month to 18,3 μg per patient/month. At the end of the study 60% of the patients received sevelamer hydrochloride at the mean dosage of 4800 mg per day. Haemoglobin remains stable. Bicarbonate level decreased due to a minor prescription in calcium carbonate. Under statins the ratio total cholesterol/HDL cholesterol decreased to 3,3. Conclusion A modification in the therapeutic strategy offer to patients undergoing haemodialysis, the possibility to achieve the K/DOQI TM recommendations with the hope to obtain a beneficial effect on patient outcomes.