Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study

Maurizio Gallieni, Nicola De Luca, Domenico Santoro, Gina Meneghel, Marco Formica, Giuseppe Grandaliano, Francesco Pizzarelli, Maria Cossu, Giuseppe Segoloni, Giuseppe Quintaliani, Salvatore Di Giulio, Antonio Pisani, Moreno Malaguti, Cosimo Marseglia, Lamberto Oldrizzi, Mario Pacilio, Giuseppe Conte, Antonio Dal Canton, Roberto Minutolo

Research output: Contribution to journalArticle

Abstract

Background: Knowledge about mineral bone disorder (MBD) management in non-dialysis chronic kidney disease (ND-CKD) patients is scarce, although essential to identifying areas for therapeutic improvement. Methods: We prospectively evaluated current management of CKD-MBD in two visits, performed 6 months apart, in 727 prevalent ND-CKD stage 3b–5 patients from 19 nephrology clinics. Therapeutic inertia was defined as lack of treatment despite hyperphosphatemia and/or hypocalcemia, and/or hyperparathyroidism. The primary endpoint was the prevalence of achieved target for CKD-MBD parameters and related treatments (phosphate binders, vitamin D and calcium supplements). The secondary endpoint was the assessment of prevalence and clinical correlates of therapeutic inertia. Results: Over 65 % of patients did not reach parathormone (PTH) targets, while 15 and 19 % did not reach phosphate and calcium targets, respectively. The proportion of untreated patients decreased from stage 3b to 5 (at baseline, from 60 to 16 %, respectively). From baseline to the 6-month visit, the achievement of targets remained stable. Low protein diet was prescribed in 26 % of patients, phosphate binders in 17.3 % (calcium-based binders 15.5 %, aluminium binders 1.8 %), and vitamin D in 50.5 %. The overall prevalence of therapeutic inertia at the 6-month visit was 34.0 % (for hyperphosphatemia, 54.3 %). Compared to CKD stage 3, the likelihood of therapeutic inertia was 40 and 68 % lower at stage 4 and 5, respectively. Conclusions: PTH, calcium and phosphate targets were not reached in a significant proportion of patients. One-third of patients with at least one MBD parameter not-at-target remained untreated. Therapeutic inertia regarding CKD-MBD treatment may be a major barrier to optimizing the prevention and cure of CKD-MBD.

Original languageEnglish
Pages (from-to)71-78
Number of pages8
JournalJournal of Nephrology
Volume29
Issue number1
DOIs
Publication statusPublished - Feb 1 2016

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Nephrology
Multicenter Studies
Minerals
Prospective Studies
Bone and Bones
Hyperphosphatemia
Therapeutics
Parathyroid Hormone
Chronic Renal Insufficiency
Vitamin D
Phosphates
Calcium
Protein-Restricted Diet
Hypocalcemia
Hyperparathyroidism
Aluminum

Keywords

  • Calcium
  • Chronic kidney disease
  • Phosphate
  • PTH
  • Therapeutic inertia
  • Treatment
  • Vitamin D

ASJC Scopus subject areas

  • Nephrology

Cite this

Gallieni, M., De Luca, N., Santoro, D., Meneghel, G., Formica, M., Grandaliano, G., ... Minutolo, R. (2016). Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study. Journal of Nephrology, 29(1), 71-78. https://doi.org/10.1007/s40620-015-0202-4

Management of CKD-MBD in non-dialysis patients under regular nephrology care : a prospective multicenter study. / Gallieni, Maurizio; De Luca, Nicola; Santoro, Domenico; Meneghel, Gina; Formica, Marco; Grandaliano, Giuseppe; Pizzarelli, Francesco; Cossu, Maria; Segoloni, Giuseppe; Quintaliani, Giuseppe; Di Giulio, Salvatore; Pisani, Antonio; Malaguti, Moreno; Marseglia, Cosimo; Oldrizzi, Lamberto; Pacilio, Mario; Conte, Giuseppe; Dal Canton, Antonio; Minutolo, Roberto.

In: Journal of Nephrology, Vol. 29, No. 1, 01.02.2016, p. 71-78.

Research output: Contribution to journalArticle

Gallieni, M, De Luca, N, Santoro, D, Meneghel, G, Formica, M, Grandaliano, G, Pizzarelli, F, Cossu, M, Segoloni, G, Quintaliani, G, Di Giulio, S, Pisani, A, Malaguti, M, Marseglia, C, Oldrizzi, L, Pacilio, M, Conte, G, Dal Canton, A & Minutolo, R 2016, 'Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study', Journal of Nephrology, vol. 29, no. 1, pp. 71-78. https://doi.org/10.1007/s40620-015-0202-4
Gallieni, Maurizio ; De Luca, Nicola ; Santoro, Domenico ; Meneghel, Gina ; Formica, Marco ; Grandaliano, Giuseppe ; Pizzarelli, Francesco ; Cossu, Maria ; Segoloni, Giuseppe ; Quintaliani, Giuseppe ; Di Giulio, Salvatore ; Pisani, Antonio ; Malaguti, Moreno ; Marseglia, Cosimo ; Oldrizzi, Lamberto ; Pacilio, Mario ; Conte, Giuseppe ; Dal Canton, Antonio ; Minutolo, Roberto. / Management of CKD-MBD in non-dialysis patients under regular nephrology care : a prospective multicenter study. In: Journal of Nephrology. 2016 ; Vol. 29, No. 1. pp. 71-78.
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AU - Gallieni, Maurizio

AU - De Luca, Nicola

AU - Santoro, Domenico

AU - Meneghel, Gina

AU - Formica, Marco

AU - Grandaliano, Giuseppe

AU - Pizzarelli, Francesco

AU - Cossu, Maria

AU - Segoloni, Giuseppe

AU - Quintaliani, Giuseppe

AU - Di Giulio, Salvatore

AU - Pisani, Antonio

AU - Malaguti, Moreno

AU - Marseglia, Cosimo

AU - Oldrizzi, Lamberto

AU - Pacilio, Mario

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AU - Dal Canton, Antonio

AU - Minutolo, Roberto

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N2 - Background: Knowledge about mineral bone disorder (MBD) management in non-dialysis chronic kidney disease (ND-CKD) patients is scarce, although essential to identifying areas for therapeutic improvement. Methods: We prospectively evaluated current management of CKD-MBD in two visits, performed 6 months apart, in 727 prevalent ND-CKD stage 3b–5 patients from 19 nephrology clinics. Therapeutic inertia was defined as lack of treatment despite hyperphosphatemia and/or hypocalcemia, and/or hyperparathyroidism. The primary endpoint was the prevalence of achieved target for CKD-MBD parameters and related treatments (phosphate binders, vitamin D and calcium supplements). The secondary endpoint was the assessment of prevalence and clinical correlates of therapeutic inertia. Results: Over 65 % of patients did not reach parathormone (PTH) targets, while 15 and 19 % did not reach phosphate and calcium targets, respectively. The proportion of untreated patients decreased from stage 3b to 5 (at baseline, from 60 to 16 %, respectively). From baseline to the 6-month visit, the achievement of targets remained stable. Low protein diet was prescribed in 26 % of patients, phosphate binders in 17.3 % (calcium-based binders 15.5 %, aluminium binders 1.8 %), and vitamin D in 50.5 %. The overall prevalence of therapeutic inertia at the 6-month visit was 34.0 % (for hyperphosphatemia, 54.3 %). Compared to CKD stage 3, the likelihood of therapeutic inertia was 40 and 68 % lower at stage 4 and 5, respectively. Conclusions: PTH, calcium and phosphate targets were not reached in a significant proportion of patients. One-third of patients with at least one MBD parameter not-at-target remained untreated. Therapeutic inertia regarding CKD-MBD treatment may be a major barrier to optimizing the prevention and cure of CKD-MBD.

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