[How to reach and maintain the K/DOQI recommendations for bone and mineral metabolism in patients undergoing haemodialysis: an efficient strategy].
BACKGROUND
Recent publications have indicated that alterations in bone and mineral metabolism are known to participate to a high mortality rate in patients undergoing haemodialysis. A new therapeutic strategy is progressively undertaken in the dialysis unit over a 36 months period covering years 2002 to 2004.


METHODS
This new strategy includes the prescription of non-calcium, non-aluminium phosphate binder, sevelamer hydrochloride, an increase in vitamin D analogues prescription and a moderation in calcium carbonate administration. Sixty patients participated to the entire study and are evaluated three times a year on the four K/DOQI parameters. Other indicators such as haemoglobin, bicarbonate, total cholesterol and HDL cholesterol levels were studied.


RESULTS
At the beginning of the study, 7% of the patients achieved the four K/DOQI parameters. This proportion seemed identical to those observed in the major studies. But progressively with the new therapeutic strategy 13%, then 21%, and at the end of the study 35% reached the four criteria. Therapeutic calcium intakes decreased from 100 g per patient/month to 28 g per patient-month. Prescription of vitamin D analogues increased from 3.3 microg per patient-month to 18.3 microg per patient/month. At the end of the study 60% of the patients received sevelamer hydrochloride at the mean dosage of 4800 mg per day. Haemoglobin remains stable. Bicarbonate level decreased due to a minor prescription in calcium carbonate. Under statins the ratio total cholesterol/HDL cholesterol decreased to 3.3.


CONCLUSIONS
A modification in the therapeutic strategy offer to patients undergoing haemodialysis, the possibility to achieve the K/DOQI recommendations with the hope to obtain a beneficial effect on patient outcomes.
Rottembourg
Jacques
J
Centre Suzanne-Levy, clinique du Mont-Louis, Paris, France. jacques.rottembourg@wanadoo.fr
Diab
Raji
R
Boulechfar
Hacène
H
D000368:Aged; D001847:Bone Diseases / Q000517:prevention & control*; D001842:Bone and Bones / Q000378:metabolism*; D002614:Chelating Agents / Q000627:therapeutic use; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000628:therapy; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism*; D011073:Polyamines / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects; D000069603:Sevelamer; D016896:Treatment Outcome
D002614:Chelating Agents; D008903:Minerals; D011073:Polyamines; D000069603:Sevelamer