Compliance with mineral metabolism targets in haemodialysis patients: moving backwards?
BACKGROUND
To standardize therapy and improve the clinical outcome for chronic haemodialysis (HD) patients, guidelines have been developed for mineral metabolism management. We evaluated compliance with different mineral metabolism guidelines.


METHODS
2,951 chronic HD patients from 61 dialysis centres in Spain were studied. Mineral metabolism management data from a 1-year period were analysed according to KDOQI, KDIGO, and Spanish guidelines.


RESULTS
Only 1% (KDOQI), 6% (KDIGO) and 11% (Spanish guidelines) of patients continuously achieved total calcium (Ca), phosphate (P) and parathyroid hormone (PTH) target-range values during the year with higher percentages if we considered the 1-year average. The yearly Ca, P and iPTH average accomplished Spanish guidelines with different percentage among centres: CA 62-100%, P 59-91%, PTH 61-89%, and 28-77% considering all three targets together. The KDIGO guidelines recommend similar percentages except for P (33-77%). No differences were found related to eKt/V, online haemodiafiltration/HD, weight, body mass index, or dialysis vintage. They were only related to age, blood flow, effective treatment time, and dialysate calcium but without relevant clinical differences. Patients outside the target ranges generated significantly higher treatment costs.


CONCLUSIONS
Compliance with mineral metabolism targets in HD patients was poor and showed a wide variation between treatment centres.
NephroCare Medical Management, Fresenius Medical Care, Hospital Universitario 12 de Octubre, Madrid, Spain.
I
I
Palomares
R
R
Ramos
A
A
Martin-Malo
J I
JI
Merello
M
M
Praga
J
J
Luño
A L M
AL
de Francisco
D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D017410:Practice Guidelines as Topic; D012016:Reference Values; D006435:Renal Dialysis / Q000191:economics / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
D008903:Minerals; D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium