title: Control of mineral metabolism and bone disease in haemodialysis patients: which optimal targets?
abstract: BACKGROUND
  There is a high drug treatment burden on patients receiving long-term dialysis therapy. Abnormalities of calcium and phosphate metabolism are associated with increased mortality, and attempts to correct these disturbances may improve survival.
  
  
  METHODS
  We prospectively evaluated the targets of the currently used Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 8377 prevalent patients receiving intermittent haemodialysis therapy in France from July 2007 to December 2009.
  
  
  RESULTS
  Adjusted Cox analyses showed that only one among six targets was predictive of mortality, i.e. a serum intact parathyroid hormone (iPTH) <130 pg/mL. A continuous risk analysis using fractional polynomials showed a 10% increase in hazard ratio (HR) for mortality for a serum phosphate <0.71 (2.2) and >1.98 (6.14) mmol/L (mg/dL), a non-corrected serum calcium <1.59 (6.37) and >2.41 (9.66) mmol/L (mg/dL) and a serum iPTH <100 and >1090 pg/mL.
  
  
  CONCLUSIONS
  The findings of our observational study confirm the existence of a grey zone, in which precise biochemical targets are difficult to define, with the exception of avoiding extreme values. Given the absence of intervention trials proving the clinical usefulness of phosphorus control, and pending the results of large clinical trials on the effect of optimal PTH and calcium control on hard outcomes, the present findings may help to refine future recommendations for the treatment of chronic haemodialysis patients.
authors.affiliation: Department of Nephrology, Hôpital Edouard Herriot, Université de Lyon, CENS, Lyon, France. denis.fouque@chu-lyon.fr
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Hubert
authors.initials: H
authors.lastname: Roth
authors.forename: Solenne
authors.initials: S
authors.lastname: Pelletier
authors.forename: Gérard M
authors.initials: GM
authors.lastname: London
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bouchet
authors.forename: Tilman
authors.initials: T
authors.lastname: Drüeke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D002118:Calcium / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005602:France; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium