Achieving K/DOQI laboratory target values for bone and mineral metabolism:: An uphill battle

被引:53
作者
Al Aly, Z [1 ]
González, EA [1 ]
Martin, KJ [1 ]
Gellens, ME [1 ]
机构
[1] St Louis Univ, Div Nephrol, St Louis, MO 63110 USA
关键词
chronic kidney disease; secondary hyperparathyroidism; metabolic bone disease; renal osteodystrophy; hyperphosphatemia;
D O I
10.1159/000080087
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: The National Kidney Foundation has recently published the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease (CKD). According to these guidelines, in patients with stage 5 CKD, the adjusted calcium level should be 8.4-9.5 mg/dl, the serum phosphate should be 3.5-5.5 mg/dl, the calcium phosphorous product should be <55 mg(2)/dl(2) and the intact parathyroid hormone (PTH) level should be 150-300 pg/ml. Methods: In order to evaluate our ability to meet these targets, we reviewed laboratory parameters of bone and mineral metabolism of 140 patients over a 6-month period in an inner city hemodialysis unit. Serum calcium and phosphate levels were determined using standard assays and PTH levels were determined using the Nichols Intact PTH assay. Results: We found that the levels of serum calcium and serum phosphorus fell within the range recommended by the K/DOQI guidelines 49 and 36% of the time respectively. 57% of the determinations for calcium x phosphorus product were <55 mg(2)/dl(2). PTH levels were within the recommended values in 20% of the determinations. Only 7% of the determinations met all four criteria simultaneously in spite of meeting other K/DOQI targets such as hematocrit and dialysis adequacy. Conclusion: These data indicate that current practice for the management of bone and mineral metabolism in hemodialysis falls far short of meeting the K/DOQI guidelines. Copyright (C) 2004 S. Karger AG, Basel.
引用
收藏
页码:422 / 426
页数:5
相关论文
共 14 条
[1]  
Block GA, 2000, CLIN NEPHROL, V54, P318
[2]   Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: Recommendations for a change in management [J].
Block, GA ;
Port, FK .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2000, 35 (06) :1226-1237
[3]  
Block GA, 2003, J AM SOC NEPHROL, V14, p474A
[4]   Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: A national study [J].
Block, GA ;
Hulbert-Shearon, TE ;
Levin, NW ;
Port, FK .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1998, 31 (04) :607-617
[5]  
Cannata-Andia J, 2003, J AM SOC NEPHROL, V14, p474A
[6]   Hyperphosphataemia as a cardiovascular risk factor -: how to manage the problem [J].
Cannata-Andía, JB ;
Rodríguez-García, M .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2002, 17 :16-19
[7]   Long-term effects of sevelamer hydrochloride on the calcium x phosphate product and lipid profile of haemodialysis patients [J].
Chertow, GM ;
Burke, SK ;
Dillon, MA ;
Slatopolsky, E .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 1999, 14 (12) :2907-2914
[8]  
EKNOYAN G, 2003, AM J KIDNEY DIS S, V42, P1
[9]  
Gallieni M, 2001, J NEPHROL, V14, P176
[10]  
Ganesh SK, 2001, J AM SOC NEPHROL, V12, P2131, DOI 10.1681/ASN.V12102131