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 language | English |
|---|---|
| Pages (from-to) | 71-78 |
| Number of pages | 8 |
| Journal | Journal of Nephrology |
| Volume | 29 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Feb 1 2016 |
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Keywords
- Calcium
- Chronic kidney disease
- Phosphate
- PTH
- Therapeutic inertia
- Treatment
- Vitamin D
ASJC Scopus subject areas
- Nephrology
Cite this
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, G.; Quintaliani, Giuseppe; Di Giulio, S.; Pisani, Antonio; Malaguti, Moreno; Marseglia, C. D.; 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 journal › Article
}
TY - JOUR
T1 - Management of CKD-MBD in non-dialysis patients under regular nephrology care
T2 - a prospective multicenter study
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, G.
AU - Quintaliani, Giuseppe
AU - Di Giulio, S.
AU - Pisani, Antonio
AU - Malaguti, Moreno
AU - Marseglia, C. D.
AU - Oldrizzi, Lamberto
AU - Pacilio, Mario
AU - Conte, Giuseppe
AU - Dal Canton, Antonio
AU - Minutolo, Roberto
PY - 2016/2/1
Y1 - 2016/2/1
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.
AB - 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.
KW - Calcium
KW - Chronic kidney disease
KW - Phosphate
KW - PTH
KW - Therapeutic inertia
KW - Treatment
KW - Vitamin D
UR - http://www.scopus.com/inward/record.url?scp=84961319351&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84961319351&partnerID=8YFLogxK
U2 - 10.1007/s40620-015-0202-4
DO - 10.1007/s40620-015-0202-4
M3 - Article
VL - 29
SP - 71
EP - 78
JO - Journal of Nephrology
JF - Journal of Nephrology
SN - 1121-8428
IS - 1
ER -