title: Impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in a large dialysis network.
abstract: BACKGROUND
  The impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease has not been assessed.
  
  
  METHODS
  We compared albumin-adjusted serum calcium, phosphate, calcium x phosphate (Ca x P) product, and parathyroid hormone (PTH) values among active hemodialysis patients who received care at Dialysis Clinic Inc facilities during 8-month periods before (n = 9,516) and after (n = 9,543) the October 2003 release of the KDOQI guidelines. We examined the impact of missed sessions, abbreviated sessions, and patient-dietitian ratio on achievement of consistent control (defined as >or= 75% values within guideline targets) for each parameter. We also evaluated whether achievement of consistent control of a given parameter precluded control of another.
  
  
  RESULTS
  There was a modest decrease in mean per-patient concentration for all mineral metabolic indicators after release of the guidelines. Similarly, the proportion of values within the recommended ranges for serum calcium, phosphate, and Ca x P product increased, but remained unchanged for PTH. The likelihood of achieving consistent control for each indicator increased when other parameters were concomitantly in range. Missed dialysis sessions were associated with a lower likelihood of achieving consistent control of calcium, phosphate, and Ca x P product levels, whereas abbreviated sessions were associated inversely with consistent achievement of phosphate and Ca x P product target levels. Variations in patient-dietitian ratio had no discernible association with mineral metabolic control.
  
  
  CONCLUSIONS
  The KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease had a small, but noticeable, effect in the year after their release. Additional studies should evaluate whether achievement of the prescribed target levels confers an advantage with respect to relevant clinical outcomes.
authors.affiliation: Department of Medicine, Division of Nephrology, St Michael's Hospital and University of Toronto, Ontario, Canada. ron.wald@utoronto.ca
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Francesca
authors.initials: F
authors.lastname: Tentori
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Philip G
authors.initials: PG
authors.lastname: Zager
authors.forename: Dana C
authors.initials: DC
authors.lastname: Miskulin
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology*; D001847:Bone Diseases / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000639:trends; D016896:Treatment Outcome