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Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges.
Nephrol Dial Transplant. 2007 Apr; 22(4):1171-6.ND

Abstract

BACKGROUND

Dialysis Outcomes and Practice Patterns Study has shown that the proportion of haemodialysis patients with adequate mineral metabolism parameters according to the Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines is very low. The adequacy of such parameters in relation to the recommended ranges in patients with different chronic kidney disease (CKD) stages has not been reported. The objective of this study is to provide an in-depth description of mineral metabolism in the early stages of CKD in a European population, and to compare it with current recommendations for stages 3-5 (K/DOQI guidelines).

METHODS

A total of 1836 patients were classified into stages 1-5 according to K/DOQI guidelines. The following clinical and biochemical data were recorded: age, gender, CKD aetiology, presence of diabetes, serum creatinine, creatinine clearance, serum phosphate, calcium, CaxP product and intact parathyroid hormone (PTH).

RESULTS

A decrease in 1,25-dihydroxyvitamin D and an increase in PTH are the earliest mineral metabolism alterations in CKD, while serum calcium and phosphate are altered later in the course of CKD. The percentages of patients with serum levels within the recommended K/DOQI guidelines for stages 3, 4 and 5 were as follows: serum calcium: 90.7, 85.6 and 55; serum phosphate: 90.9, 77.1 and 70.3; iPTH 42.4, 24.6 and 46.8 and Ca x P product 99.9, 99.6 and 83.8, respectively. The percentages of patients who had all four parameters within the recommended ranges were 34.9, 18.4 and 21.6 for stages 3, 4 and 5, respectively.

CONCLUSION

Mineral metabolism disturbances start early in the course of CKD. The first alterations to take place are a 1,25-dihydroxyvitamin D decrease, a 24 h urine phosphate decrease and a PTH elevation, which show significant level variation when the glomerular filtration rate falls below 60 ml/min. K/DOQI recommended levels for mineral metabolism parameters are difficult to accomplish, in particular for PTH levels.

Authors+Show Affiliations

Hospital Universitari Arnau de Vilanova, Av Rovira Roure, 25198 Lleida, Spain. lcraver@arnau.scs.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17205962

Citation

Craver, Lourdes, et al. "Mineral Metabolism Parameters Throughout Chronic Kidney Disease Stages 1-5--achievement of K/DOQI Target Ranges." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 22, no. 4, 2007, pp. 1171-6.
Craver L, Marco MP, Martínez I, et al. Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges. Nephrol Dial Transplant. 2007;22(4):1171-6.
Craver, L., Marco, M. P., Martínez, I., Rue, M., Borràs, M., Martín, M. L., Sarró, F., Valdivielso, J. M., & Fernández, E. (2007). Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 22(4), 1171-6.
Craver L, et al. Mineral Metabolism Parameters Throughout Chronic Kidney Disease Stages 1-5--achievement of K/DOQI Target Ranges. Nephrol Dial Transplant. 2007;22(4):1171-6. PubMed PMID: 17205962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges. AU - Craver,Lourdes, AU - Marco,Maria Paz, AU - Martínez,Isabel, AU - Rue,Montserrat, AU - Borràs,Merce, AU - Martín,Maria Luisa, AU - Sarró,Felipe, AU - Valdivielso,José Manuel, AU - Fernández,Elvira, Y1 - 2007/01/05/ PY - 2007/1/9/pubmed PY - 2007/7/25/medline PY - 2007/1/9/entrez SP - 1171 EP - 6 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 22 IS - 4 N2 - BACKGROUND: Dialysis Outcomes and Practice Patterns Study has shown that the proportion of haemodialysis patients with adequate mineral metabolism parameters according to the Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines is very low. The adequacy of such parameters in relation to the recommended ranges in patients with different chronic kidney disease (CKD) stages has not been reported. The objective of this study is to provide an in-depth description of mineral metabolism in the early stages of CKD in a European population, and to compare it with current recommendations for stages 3-5 (K/DOQI guidelines). METHODS: A total of 1836 patients were classified into stages 1-5 according to K/DOQI guidelines. The following clinical and biochemical data were recorded: age, gender, CKD aetiology, presence of diabetes, serum creatinine, creatinine clearance, serum phosphate, calcium, CaxP product and intact parathyroid hormone (PTH). RESULTS: A decrease in 1,25-dihydroxyvitamin D and an increase in PTH are the earliest mineral metabolism alterations in CKD, while serum calcium and phosphate are altered later in the course of CKD. The percentages of patients with serum levels within the recommended K/DOQI guidelines for stages 3, 4 and 5 were as follows: serum calcium: 90.7, 85.6 and 55; serum phosphate: 90.9, 77.1 and 70.3; iPTH 42.4, 24.6 and 46.8 and Ca x P product 99.9, 99.6 and 83.8, respectively. The percentages of patients who had all four parameters within the recommended ranges were 34.9, 18.4 and 21.6 for stages 3, 4 and 5, respectively. CONCLUSION: Mineral metabolism disturbances start early in the course of CKD. The first alterations to take place are a 1,25-dihydroxyvitamin D decrease, a 24 h urine phosphate decrease and a PTH elevation, which show significant level variation when the glomerular filtration rate falls below 60 ml/min. K/DOQI recommended levels for mineral metabolism parameters are difficult to accomplish, in particular for PTH levels. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/17205962/Mineral_metabolism_parameters_throughout_chronic_kidney_disease_stages_1_5__achievement_of_K/DOQI_target_ranges_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfl718 DB - PRIME DP - Unbound Medicine ER -