title: Management of mineral metabolism in hemodialysis patients: discrepancy between interventions and perceived causes of failure.
abstract: BACKGROUND
  Mineral and bone disorders (MBD) in patients undergoing hemodialysis (HD) are a major clinical complication. Current therapeutic strategies do not attain the expected results. The Italian audit on mineral metabolism was implemented to investigate MBD management through a "patient-oriented" approach.
  
  
  METHODS
  Clinical and laboratory data pertinent to MBD from 509 prevalent adult patients on chronic HD were recorded and examined (audit), after which individual strategies were elaborated to improve MBD control. Their effectiveness was evaluated 6 months after the audit (Post-6).
  
  
  RESULTS
  The audit disclosed poor MBD control in a high percentage of patients (56 %). Low compliance to treatment was the major determinant of failure (in 43.5 % of cases). Logistic regression showed a direct correlation between high degree of compliance and the achievement of therapeutic targets, e.g. parathyroid hormone: odds ratio (OR) 2.48, p = 0.015. In contrast, a minority of the proposed interventions (14.7 %) included strategies to improve patient compliance. At Post-6, despite a significant increase in drug prescription (p < 0.05 vs. audit), the rate of successful MBD control was unchanged.
  
  
  CONCLUSIONS
  Low compliance with treatment is a major, but still neglected, cause of failure in the achievement of MBD control in HD patients.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy. pasqualeesposito@hotmail.com.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Esposito
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rampino
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Gregorini
authors.affiliation: Unit of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.affiliation: Unit of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: Divisione di Nefrologia e Dialisi, Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Malberti
authors.affiliation: Nephrology, Dialysis and Transplantation Unit, City of Health and Science of Turin, Regina Margherita Children's Hospital, Turin, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Coppo
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dal Canton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D015415:Biomarkers
keywords: Clinical audit; Compliance; Hemodialysis; Mineral disorders; Quality improvement