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, G. Segoloni, Giuseppe Quintaliani, S. Di Giulio, Antonio Pisani, Moreno Malaguti, C. D. Marseglia, Lamberto Oldrizzi, Mario Pacilio, Giuseppe Conte, Antonio Dal Canton, Roberto Minutolo

Research output: Contribution to journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Nephrology

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