title: Age-dependent parathormone levels and different CKD-MBD treatment practices of dialysis patients in Hungary--results from a nationwide clinical audit.
abstract: BACKGROUND
  Achieving target levels of laboratory parameters of bone and mineral metabolism in chronic kidney disease (CKD) patients is important but also difficult in those living with end-stage kidney disease. This study aimed to determine if there are age-related differences in chronic kidney disease-mineral and bone disorder (CKD-MBD) characteristics, including treatment practice in Hungarian dialysis patients.
  
  
  METHODS
  Data were collected retrospectively from a large cohort of dialysis patients in Hungary. Patients on hemodialysis and peritoneal dialysis were also included. The enrolled patients were allocated into two groups based on their age (<65 years and ≥65 years). Characteristics of the age groups and differences in disease-related (epidemiology, laboratory, and treatment practice) parameters between the groups were analyzed.
  
  
  RESULTS
  A total of 5008 patients were included in the analysis and the mean age was 63.4±14.2 years. A total of 47.2% of patients were women, 32.8% had diabetes, and 11.4% were on peritoneal dialysis. Diabetes (37.9% vs 27.3%), bone disease (42.9% vs 34.1%), and soft tissue calcification (56.3% vs 44.7%) were more prevalent in the older group than the younger group (p<0.001 for all). We found an inverse relationship between age and parathyroid hormone (PTH) levels (p<0.001). Serum PTH levels were lower in patients with diabetes compared with those without diabetes below 80 years (p<0.001). Diabetes and age were independently associated with serum PTH levels (interaction: diabetes × age groups, p=0.138). Older patients were more likely than younger patients to achieve laboratory target ranges for each parameter (Ca: 66.9% vs 62.1%, p<0.001; PO4: 52.6% vs 49.2%, p<0.05; and PTH: 50.6% vs 46.6%, p<0.01), and for combined parameters (19.8% vs 15.8%, p<0.001). Older patients were less likely to receive related medication than younger patients (66.9% vs 79.7%, p<0.001).
  
  
  CONCLUSIONS
  The achievement of laboratory target ranges for bone and mineral metabolism and clinical practice in CKD depends on the age of the patients. A greater proportion of older patients met target criteria and received less medication compared with younger patients.
authors.affiliation: 2nd Department of Internal Medicine Department Section of Geriatrics, Semmelweis University Faculty of Medicine, Budapest, Hungary. ikiss@enternet.hu
authors.forename: István
authors.initials: I
authors.lastname: Kiss
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Kiss
authors.forename: Csaba
authors.initials: C
authors.lastname: Ambrus
authors.forename: András
authors.initials: A
authors.lastname: Szabó
authors.forename: János
authors.initials: J
authors.lastname: Szegedi
authors.forename: József
authors.initials: J
authors.lastname: Balla
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Ladányi
authors.forename: Botond
authors.initials: B
authors.lastname: Csiky
authors.forename: Ottó
authors.initials: O
authors.lastname: Árkossy
authors.forename: Marietta
authors.initials: M
authors.lastname: Török
authors.forename: Sándor
authors.initials: S
authors.lastname: Túri
authors.forename: Imre
authors.initials: I
authors.lastname: Kulcsár
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D054869:Clinical Audit / Q000379:methods*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone