Treating mineral metabolism disorders in patients undergoing long hemodialysis: a search for an optimal strategy.
In hemodialysis (HD) patients, mineral metabolism (MM) disorders have been associated with an increased mortality rate. We report the evolution of MM parameters in a stable HD population undergoing long hemodialysis by performing an annual cross-sectional analysis for every year from 1994 to 2008. The therapeutic strategy has changed: the dialysate calcium concentration has decreased from a mean of 1.7 +/- 0.1 to 1.5 +/- 0.07 mmol/L and has been adapted to parathyroid hormone serum levels (from 1 to 1.75 mmol/L). The use of calcium-based and aluminum-based phosphate binders has decreased and they have been replaced by sevelamer; alfacalcidol has partly been replaced by native vitamin D. The percentage of patients with a parathyroid hormone serum level between 150 and 300 pg/mL has increased from 9% to 67% (P<0.001); the percentage of patients with phosphataemia between 1.15 and 1.78 mmol/L has increased from 39% to 84% (P<0.001). The percentage of those with albumin-corrected calcemia between 2.1 and 2.37 mmol/L has increased from 29% to 61% (P<0.001), and that of patients with a calcium-phosphorous product (Ca x P) level >4.4 mmol/L decreased from 8.8% to 2% (P=0.02). Although patients undergo long and intensive HD treatment, MM disorders are common. However, an appropriate strategy, mostly consisting of native vitamin D supplementation, progressive replacement of calcium-based phosphate binders with non-calcium-based ones, and individualization of dialysis session duration and dialysate calcium concentration, would result in a drastic improvement.
Jean
Guillaume
G
Centre de Rein Artificiel, 69160 Tassin la Demi-lune, France. guillaume-jean-crat@wanadoo.fr
Vanel
Thierry
T
Terrat
Jean-Claude
JC
Hurot
Jean-Marc
JM
Lorriaux
Christie
C
Mayor
Brice
B
Chazot
Charles
C
D000368:Aged; D002614:Chelating Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D006801:Humans; D054559:Hyperphosphatemia / Q000628:therapy*; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies
D002614:Chelating Agents