Effect of aggressive osteodystrophy management on clinical outcomes in stage 5 chronic kidney disease.
OBJECTIVE
The study investigated whether the type of bone disease management (aggressive versus conventional) had an impact on clinical outcomes, namely bone health measures (e.g., biointact parathyroid hormone [BiPTH], serum corrected calcium [cCa] level, serum phosphorus [phos] level, and corrected calcium-phosphorus product [cCaPO(4)]).


METHODS
Retrospective chart review of 173 closed medical records of maintenance hemodialysis patients on thrice-weekly therapy from January 1, 2005, through December 31, 2005. Two Conventional Management (i.e., control group) and three Aggressive Management (i.e., treatment group) dialysis facilities were enrolled.


RESULTS
There was a significant interaction for group assignment and BiPTH levels (F = 4.12, P = .01), with the Aggressive Group trending toward lower BiPTH levels than the Conventional Group. The Conventional Group experienced a significantly lower mean annualized serum cCa level (F = 8.85, P = .003), and used non-calcium-based binders significantly more (P < .0005) than the Aggressive Group. In terms of serum phos level, the Aggressive Group had a significantly lower (F = 2.73, P = .05) value than the Conventional Group. No significant differences were reported for cCaPO(4) product (F = 1.87, P = .17). The percentage of the total sample that achieved target range for all bone health measures included 29.8% (n = 50).


CONCLUSIONS
The study demonstrated that aggressive bone disease management appears to be as effective as traditional interventions in the treatment of mineral and bone metabolism disorders in chronic kidney disease.
Byham-Gray
Laura
L
Department of Nutritional Sciences, University of Medicine and Dentistry of New Jersey, School of Health-Related Professions, Stratford, NJ 08084, USA. laura.byham-gray@umdnj.edu
Drasher
Tammy
T
Deckman
Karen
K
Graham
Diane
D
Liftman
Carol
C
Roberto
Linda
L
Peiffer
Phyllis
P
Denmark
Robert
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000628:therapy*; D004032:Diet; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D002614:Chelating Agents; D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium