title: The impact of prior multidisciplinary predialysis care on mineral metabolic control among chronic hemodialysis patients.
abstract: OBJECTIVE
  Disordered mineral metabolism is independently associated with mortality among chronic dialysis patients. We hypothesized that, upon dialysis start, biochemical markers of mineral metabolism would be better controlled among patients who had received multidisciplinary predialysis care (MDC).
  
  
  METHODS
  We conducted a retrospective cohort study of incident hemodialysis patients between 2002 and 2005. Corrected calcium (Ca), phosphate (P), calcium-phosphate product (CaxP), and intact parathyroid hormone (iPTH) at the time of dialysis initiation and over the first year thereafter were compared based on prior MDC receipt. Furthermore, we examined the relationship between the duration of MDC and mineral metabolic parameters.
  
  
  RESULTS
  67 patients received MDC and 84 patients received conventional or no nephrologist-based care. Patients who received MDC had a higher iPTH (p = 0.03) both at dialysis initiation and over the subsequent year while Ca, P, and CaxP were not significantly impacted. Among patients who received MDC, mineral metabolic values at dialysis initiation did not differ by duration of predialysis care.
  
  
  CONCLUSIONS
  The receipt of MDC had a limited effect on mineral metabolic profiles at the time of and over the first year following chronic hemodialysis initiation. The survival benefits associated with the receipt of MDC may be mediated by mechanisms other than improved mineral metabolic control.
authors.affiliation: Prosserman Centre for Health Research, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Oded
authors.initials: O
authors.lastname: Friedman
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Marc B
authors.initials: MB
authors.lastname: Goldstein
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010348:Patient Care Team; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D016896:Treatment Outcome