The DOPPS Practice Monitor for US Dialysis Care: PTH Levels and Management of Mineral and Bone Disorder in US Hemodialysis Patients

Abstract

In the US DPM sample, median PTH levels increased 32%, from August 2010 through April 2011 and have remained relatively stable since then. Black patients carry a disproportionate burden of PTH levels above 600 pg/ml (29%; vs. 17% among nonblacks). This finding warrants particular attention, since such high PTH levels have consistently been associated with adverse outcomes6–14 and the association between severe hyperparathyroidism and mortality appeared consistent in both racial groups. While we had postulated that the PPS may have led to lower utilization of MBD-related intravenous drugs, vitamin D prescription remained stable over time. Rather, the increase in PTH levels seem to have been driven mainly by adoption of more liberal PTH targets, as reported in the medical director survey. However, PTH levels >600 are above any currently recommended guidelines and likely represent a modifiable risk factor for adverse outcomes. Clinicians should take this into account especially when treating black patients, since nearly a third of them presented such high levels in the US DOPPS sample.