[Mineral and bone status in French maintenance hemodialysis patients: a comparison of June 2005 and June 2008].
BACKGROUND
Because of the high associated morbi-mortality, phosphate and calcium disorders remain a major therapeutic challenge for nephrologists. Previous studies showed that only few patients had serum calcium, phosphate and parathyroid hormone within Kidney-Disease Outcomes Quality Initiative (K/DOQI) targets.


METHODS
The French calcium and phosphate observatory monitors mineral metabolism at local, regional and national level and its follow-up every six months since 2005. More than 200 nephrologists collected more than 9000 patients' data. We compared the results recorded in June 2005 with those collected in June 2008.


RESULTS
As compared with June 2005, in June 2008 fewer patients were hypercalcemic according to the K/DOQI targets (-26.2%, p<0.001) and hyperphosphatemic (-16.5%, p<0.001), more patients were hypocalcemic (+45.5%, p<0.001) and hypophosphatemic (+8.8%, p<0.02). A greater number of patients had elevated serum PTH above 300ng/l (+17.6%, p<0.001) and fewer had a PTH lower than 150ng/l (-25.4%, p<0.001). Serum 25OH vitamin D level was 21.7+/-20.0microg/l in June 2008. Overall, 10.5% of patients met all three K/DOQI targets, an improvement compared with June 2005 (6.8%, p<0.001). Between 2005 and 2008, cinacalcet, lanthane carbonate and native vitamin D derivatives prescription increased whereas calcium-based phosphate binders, sevelamer-HCL and active vitamin D derivatives decreased.


CONCLUSIONS
Despite a significant improvement between 2005 and 2008, only few patients reach the three K/DOQI targets (10.5%) in 2008. The prospective biannual follow-up during three years will allow us to identify the impact of different treatments on calcium and phosphate metabolic control and patient's survival.
Département de néphrologie, hôpital Edouard-Herriot, place d'Arsonval, Lyon cedex 03, France.
Solenne
S
Pelletier
Hubert
H
Roth
Jean-Louis
JL
Bouchet
Tilman
T
Drueke
Thierry
T
Hannedouche
Gérard
G
London
Denis
D
Fouque
D000368:Aged; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D010710:Phosphates / Q000378:metabolism*; D006435:Renal Dialysis; D013997:Time Factors
D010710:Phosphates; D002118:Calcium