The influences of method of calcium correction and the timing of blood collection on application of the K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Japan.
We investigated the treatment of renal osteodystrophy (ROD) in Japan and problems concerning the K/DOQI Guidelines. The subjects were 3698 hemodialysis patients (2328 males and 1370 females) with a mean age of 61.4 years. On average, they had been on hemodialysis for 8.34 years. The serum phosphorus level was <3.5 mg/dL in 5% of the subjects, 3.5-5.5 mg/dL in 49%, 5.6-7.0 mg/dL in 33%, and >7.0 mg/dL in 13%. The serum calcium level was <8.4 mg/dL in 16% of the subjects, 8.4-9.5 mg/dL in 47%, 9.5-10.2 mg/dL in 22%, and >10.2 mg/dL in 15%. The intact PTH level was <150 pg/mL in 57%, 150-300 pg/mL in 27%, and >300 pg/mL in 16% of the patients. The first problem is that correcting Ca is not always performed in clinical fields. The uncorrected calcium level was 9.14+/-0.92 mg/dL, while the corrected calcium level [Ca = Ca + 0.8 x (4-Alb)] was 9.26+/-0.93 mg/dL (P < 0.05). The second problem is that the timing of blood collection is not described in the K/DOQI Guidelines. Subjects with a serum phosphorus level >7.0 mg/dL at 3 days after the previous dialysis were selected for assessment. In these patients, the midweek serum phosphorus level (7.13+/-0.15 mg/dL) at was significantly lower than that (8.11+/-0.15 mg/dL) at the beginning of the next week (P < 0.001). These results suggest that it is necessary to specify the timing of measurement and the method of Ca correction when guidelines for management of ROD are established in the future.
Yokoyama
Keitaro
K
Division of Kidney and Hypertension, Jikei University of Medicine, Tokyo, Japan. keitaro@jikei.ac.jp
Katoh
Naohiko
N
Kasai
Kenji
K
Kubo
Hitoshi
H
Murai
Seizou
S
Shoji
Ryo
R
Imamura
Noritsugu
N
Saika
Souichi
S
Yumita
Sigeru
S
Ishida
Mari
M
Takasu
Shinji
S
Kono
Takashi
T
Yoshida
Yutaka
Y
Wakabayashi
Tsunemichi
T
Kimua
Yasuo
Y
Hosoya
Tasuo
T
D000465:Algorithms; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood* / Q000378:metabolism / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000209:etiology; D007564:Japan; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000009:adverse effects*; D013997:Time Factors; D014481:United States; D014807:Vitamin D / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; C470125:PTH protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium