title: COSMOS: the dialysis scenario of CKD-MBD in Europe.
abstract: BACKGROUND
  Chronic kidney disease-mineral and bone disorders (CKD-MBD) are important complications of CKD5D patients that are associated with mortality.
  
  
  METHODS
  COSMOS is a multicentre, open cohort, prospective, observational 3-year study carried out in haemodialysis patients from 20 European countries during 2005-07. The present article describes the main characteristics of the European dialysis population, the current practice for the prevention, diagnosis and treatment of secondary hyperparathyroidism and the differences across different European regions.
  
  
  RESULTS
  The haemodialysis population in Europe is an aged population (mean age 64.8±14.2 years) with a high prevalence of diabetes (29.5%) and cardiovascular disease (76.0%), and 28.7% of patients have been on haemodialysis more than 5 years. Patients from the former Eastern countries are younger (59.3±14.3 versus 66.0±13.9), having a lower proportion of diabetics (24.1 versus 30.7%). There were relevant differences in the frequency of measurement of the main CKD-MBD biochemical parameters [Ca, P and parathyroid hormone (PTH)] and the Eastern countries showed a poorer control of these biochemical parameters (K/DOQI and K/DIGO targets). Overall, 48.0% of the haemodialysis patients received active vitamin D treatment. Calcitriol use doubled that of alfacalcidiol in the Mediterranean countries, whereas the opposite was found in the non-Mediterranean countries. The criteria followed to perform parathyroidectomy were different across Europe. In the Mediterranean countries, the level of serum PTH considered to perform parathyroidectomy was higher than in non-Mediterranean countries; as a result, in the latter, more parathyroidectomies were performed in the year previous to inclusion to COSMOS.
  
  
  CONCLUSIONS
  The COSMOS baseline results show important differences across Europe in the management of CKD-MBD.
authors.affiliation: Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Fernández-Martín
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Carrero
authors.forename: Miha
authors.initials: M
authors.lastname: Benedik
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Bos
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Aníbal
authors.initials: A
authors.lastname: Ferreira
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.forename: José Luis
authors.initials: JL
authors.lastname: Gorriz
authors.forename: Markus
authors.initials: M
authors.lastname: Ketteler
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Gérard
authors.initials: G
authors.lastname: London
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Martin
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Memmos
authors.forename: Judit
authors.initials: J
authors.lastname: Nagy
authors.forename: Manuel
authors.initials: M
authors.lastname: Naves-Díaz
authors.forename: Drasko
authors.initials: D
authors.lastname: Pavlovic
authors.forename: Minerva
authors.initials: M
authors.lastname: Rodríguez-García
authors.forename: Boleslaw
authors.initials: B
authors.lastname: Rutkowski
authors.forename: Vladimir
authors.initials: V
authors.lastname: Teplan
authors.forename: Christian
authors.initials: C
authors.lastname: Tielemans
authors.forename: Dierik
authors.initials: D
authors.lastname: Verbeelen
authors.forename: Rudolf P
authors.initials: RP
authors.lastname: Wüthrich
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Camblor
authors.forename: Iván
authors.initials: I
authors.lastname: Cabezas-Rodriguez
authors.forename: José Emilio
authors.initials: JE
authors.lastname: Sánchez-Alvarez
authors.forename: Jorge B
authors.initials: JB
authors.lastname: Cannata-Andia
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D002118:Calcium / Q000097:blood; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D007677:Kidney Function Tests; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010757:Phosphorous Acids / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D010757:Phosphorous Acids; C570063:phosphonic acid; D002118:Calcium