Are CSN and NKF-K/DOQI mineral metabolism guidelines for hemodialysis patients achievable? Results from a provincial renal program.
BACKGROUND
The calcium, phosphorus, and parathyroid hormone targets recommended by the Canadian Society of Nephrology (CSN) encompass a wider range of values as compared to the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines. We sought to compare mineral metabolism parameters within the Manitoba Renal Program (MRP) to the CSN and NKF-K/DOQI guidelines. Medication use was also examined.


METHODS
All hemodialysis patients in Manitoba were evaluated. Values for serum albumin, phosphorus, calcium, intact parathyroid hormone (PTH) and pertinent medications were collected.


RESULTS
Five hundred and forty-six patients were included in the analysis. Fifty-three per cent to 81% of MRP patients met individual CSN targets. However, only 26% of patients achieved all targets, despite high usage of phosphate (85.5% calcium carbonate, 16.1% sevelamer, 1.3% aluminum) and PTH-lowering drug therapies (30.2% calcitriol, 2.7% cinacalcet).


CONCLUSIONS
Only a small proportion of patients were able to achieve all three CSN mineral metabolism targets simultaneously. The majority of outliers presented with hyperphosphatemia or hypoparathyroidism.
Wazny
Lori D
LD
Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, MB. Lwazny@hsc.mb.ca
Raymond
Colette B
CB
Lesperance
Esther M
EM
Bernstein
Keevin N
KN
D000368:Aged; D002118:Calcium / Q000097:blood*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D015312:Hemodialysis Solutions / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D008297:Male; D008350:Manitoba; D008485:Medical Audit; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000379:methods / Q000592:standards*; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
D015312:Hemodialysis Solutions; D010281:Parathyroid Hormone; D012709:Serum Albumin; D010758:Phosphorus; D002118:Calcium