title: Reaching targets for mineral metabolism clinical practice guidelines and its impact on outcomes among Mexican chronic dialysis patients.
abstract: OBJECTIVE
  An increasing number of studies have been published concerning meeting targets of clinical guidelines for different aspects of the diagnosis and treatment of patients with end-stage renal disease. Most of these studies have shown that guideline recommendations are not always satisfied, and results outside target limits have been associated with high rates of mortality and morbidity. The objective of this study was to analyze the frequency of reaching mineral and bone metabolism-related guideline targets and its impact on clinical outcomes in Mexican chronic dialysis patients.
  
  
  METHODS
  A cohort of prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients were analyzed at baseline and followed for at least 16 months. Patients were on continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and HD and contracted HD modalities where patients received HD sessions outside institution facilities.
  
  
  RESULTS
  We studied 753 patients. The percentage of patients within target limits for phosphorus was 35%, for calcium 32%, and for PTH 12%. The most frequent pattern was hyperphosphatamia, hypercalcemia, and low PTH. This was even more frequent in CAPD patients, probably due to the high percentage of diabetic patients. Hypercalcemia was found as an independent risk factor for mortality.
  
  
  CONCLUSIONS
  The most important results suggest that guideline recommendations are not usually satisfied and that hypercalcemia, in addition to other traditional risk factors, is associated with high mortality rates. The study also detected some opportunities to improve the quality of treatment by reducing the calcium content of dialysis solutions and reducing the use of calcium carbonate as a phosphate binder.
authors: Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI. ramon.paniagua@imss.gob.mx
authors: Ramón
authors: R
authors: Paniagua
authors: María-de-Jesús
authors: MD
authors: Ventura
authors: Marcela
authors: M
authors: Ávila-Díaz
authors: Héctor
authors: H
authors: Hinojosa-Heredia
authors: Antonio
authors: A
authors: Méndez-Duran
authors: Alejandra
authors: A
authors: Cisneros
authors: Ana María
authors: AM
authors: Gómez
authors: Alfonso
authors: A
authors: Cueto-Manzano
authors: Pedro
authors: P
authors: Trinidad
authors: Gregorio T
authors: GT
authors: Obrador
authors: Elvia
authors: E
authors: García-López
authors: Bengt
authors: B
authors: Lindholm
mesh_terms: D000328:Adult; D002118:Calcium / Q000097:blood / Q000378:metabolism*; D002119:Calcium Carbonate / Q000008:administration & dosage; D015331:Cohort Studies; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism; D010530:Peritoneal Dialysis; D010758:Phosphorus / Q000097:blood / Q000378:metabolism*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D002119:Calcium Carbonate; D002118:Calcium