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Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study.
J Nephrol. 2016 Feb; 29(1):71-8.JN

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.

Authors+Show Affiliations

Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, University of Milano, via Pio II, 3, 20153, Milan, Italy. maurizio.gallieni@fastwebnet.it.Second University of Naples, Naples, Italy.University of Messina, Messina, Italy.Dolo General Hospital, Dolo-Venice, Italy.Ospedali di Savigliano e Ceva, ASL Cuneo 1, Cuneo, Italy.Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.S.M. Annunziata Hospital, Florence, Italy.SS Annunziata Hospital, Sassari, Italy.University of Turin, Turin, Italy.S. Maria della Misericordia Hospital, Perugia, Italy.S. Camillo Forlanini Hospital, Rome, Italy.University Federico II, Naples, Italy.Ospedale San Paolo, Civitavecchia, Italy.C. Poma Hospital, Mantova, Italy.Ospedale Fracastoro, San Bonifacio, Italy.Second University of Naples, Naples, Italy.Second University of Naples, Naples, Italy.Fondazione IRCSS Policlinico S. Matteo and University of Pavia, Pavia, Italy.Second University of Naples, Naples, Italy.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25986389

Citation

Gallieni, Maurizio, et al. "Management of CKD-MBD in Non-dialysis Patients Under Regular Nephrology Care: a Prospective Multicenter Study." Journal of Nephrology, vol. 29, no. 1, 2016, pp. 71-8.
Gallieni M, De Luca N, Santoro D, et al. Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study. J Nephrol. 2016;29(1):71-8.
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, 29(1), 71-8. https://doi.org/10.1007/s40620-015-0202-4
Gallieni M, et al. Management of CKD-MBD in Non-dialysis Patients Under Regular Nephrology Care: a Prospective Multicenter Study. J Nephrol. 2016;29(1):71-8. PubMed PMID: 25986389.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of CKD-MBD in non-dialysis patients under regular nephrology care: 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,Giuseppe, AU - Quintaliani,Giuseppe, AU - Di Giulio,Salvatore, AU - Pisani,Antonio, AU - Malaguti,Moreno, AU - Marseglia,Cosimo, AU - Oldrizzi,Lamberto, AU - Pacilio,Mario, AU - Conte,Giuseppe, AU - Dal Canton,Antonio, AU - Minutolo,Roberto, Y1 - 2015/05/19/ PY - 2015/01/27/received PY - 2015/04/21/accepted PY - 2015/5/20/entrez PY - 2015/5/20/pubmed PY - 2016/10/25/medline KW - Calcium KW - Chronic kidney disease KW - PTH KW - Phosphate KW - Therapeutic inertia KW - Treatment KW - Vitamin D SP - 71 EP - 8 JF - Journal of nephrology JO - J Nephrol VL - 29 IS - 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. SN - 1724-6059 UR - https://www.unboundmedicine.com/medline/citation/25986389/Management_of_CKD_MBD_in_non_dialysis_patients_under_regular_nephrology_care:_a_prospective_multicenter_study_ L2 - https://dx.doi.org/10.1007/s40620-015-0202-4 DB - PRIME DP - Unbound Medicine ER -