Adherence to K/DOQI practice guidelines for bone metabolism and disease.
OBJECTIVE
To determine adherence to Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for frequency of testing and control of parathyroid hormone (PTH), calcium, and phosphorus levels among patients with chronic kidney disease (CKD).


METHODS
Retrospective cohort.


METHODS
The analysis was performed with administrative claims data from large US managed care plans. Patients with CKD were identified based on claims and laboratory data. Patients were excluded if they were <18 years or >or=65 years old, had fewer than 18 months of continuous eligibility, or had renal cancer.


RESULTS
A total of 793 patients were identified with CKD stages 3, 4, or 5 (n = 424, n = 212, and n = 157, respectively). Serum calcium testing was conducted according to guidelines (once a year) in a high percentage of patients with stage 3 CKD (91%); however, the percentage dropped among patients with stage 4 CKD (64%), for whom the guidelines recommend testing 4 times a year. Plasma PTH and serum phosphorus levels were tested infrequently. Among those tested, a high percentage of both stage 3 and 4 CKD patients were in K/DOQI target ranges for calcium and phosphorus. However, fewer than half of the patients tested had PTH values within the target ranges.


CONCLUSIONS
There remains substantial opportunity to improve the quality of care with respect to bone and mineral metabolism in patients with CKD.
Hoy
Tracey
T
HealthCore, Inc, 800 Delaware Ave, 5th Fl, Wilmington, DE 19801-1366, USA.
Fisher
Maxine
M
Barber
Beth
B
Borker
Rohit
R
Stolshek
Brad
B
Goodman
William
W
D001847:Bone Diseases / Q000378:metabolism / Q000503:physiopathology*; D001842:Bone and Bones / Q000378:metabolism* / Q000502:physiology; D002118:Calcium / Q000097:blood*; D004032:Diet; D018450:Disease Progression; D005260:Female; D019983:Guideline Adherence; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007345:Insurance Claim Review; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009752:Nutritional Status; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies
D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium