Abstract
Introduction:Chronic kidney disease - mineral and bone disorders (CKD-MBD) are common in dialysis patients. Definition of targets for calcium (Ca), phosphorus (P), parathormone (iPTH), and alkaline phosphatase (ALP) and their treatment recommendations, are provided by international guidelines. There are few studies analyzing CKD-MBD in peritoneal dialysis (PD) patients and the impact of guidelines on mineral metabolism control. The aim of our study was to describe the prevalence of biomarkers for CKD-MBD in a large cohort of PD patients in Brazil.Methods:Data from the nation-wide prospective observational cohort BRAZPD II was used. Incident patients were followed between December 2004 and January 2011. According to KDOQI recommendations, reference ranges for total Ca were 8.4 to 9.5 mg/dL, for P, 3.5 to 5.5 mg/dL, for iPTH, 150-300 pg/mL, and for ALP, 120 U/L.Results:Mean age was 59.8 ± 16 years, 48% were male, and 43% had diabetes. In the beginning, Ca was 8.9 ± 0.9 mg/dL, and 48.3% were on the KODQI target. After 1 year, Ca increased to 9.1 ± 0.9 mg/dL and 50.4% were in the KDOQI preferred range. P at baseline was 5.2 ± 1.6 mg/dL, with 52.8% on target, declining to 4.9 ± 1.5 mg/dL after one year, when 54.7% were on target. Median iPTH at baseline was 238 (P25% 110 - P75% 426 pg/mL) and it remained stable throughout the first year; patients within target ranged from 26 to 28.5%. At the end of the study, 80% was in 3.5 meq/L Ca dialysate concentration, 66.9% of patients was taking any phosphate binder, and 25% was taking activated vitamin D.Conclusions:We observed a significant prevalence of biochemical disorders related to CKD-MBD in this dialysis population.
Highlights
Chronic kidney disease - mineral and bone disorders (CKDMBD) are common in dialysis patients
The main goal of our study was to describe the prevalence of patients meeting the Chronic kidney disease-mineral and bone disorders (CKD-MBD) KDOQI preferential range of biochemical variables, because this guideline was current at that time, especially for calcium and phosphorus targets, for patients after one year of initiation of chronic peritoneal dialysis (PD)
The registry of the use of calcitriol in the BRAZPD started in 2008 and, at the end of the study, 25% of the patients were taking oral activated vitamin D. In this large national cohort, we observed the difficulties of PD patients in achieving the CKDMBD KODQI guideline recommended range[10]
Summary
Chronic kidney disease - mineral and bone disorders (CKDMBD) are common in dialysis patients. Management of CKD-MBD, (especially) the definition of targets for biochemical parameters, namely calcium, phosphorus, parathormone, alkaline phosphatase and their treatment recommendations, are supported by current guidelines[4,5]. Studies with patients on chronic peritoneal dialysis (PD) showed strong evidence that abnormalities of mineral metabolism are associated with all-cause, cardiovascular[6], and infection-related mortality[7]. Another large national population-based longitudinal study found that in PD Chinese patients population, both hyper and hypophosphatemia and elevated alkaline phosphatase were associated with increase mortality[8]. When two of the most prescribed drugs to control mineral and bone disorders are used (calcitriol and calcium-based phosphate binders) aiming at reduction of iPTH and phosphate control, a single patient may experience hypercalcemia and/ or hyperphosphatemia and move out from guidelines’ recommended range
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