title: [Changes in mineral and bone disorder management in a French cohort of hemodialysis patients between 2008 and 2012: The National Bone and Mineral Metabolism observatory (Photo-Graphe 2 and 3)].
abstract: BACKGROUND
  Chronic kidney disease progressively induces a disorder of mineral and bone metabolism (CKD-MBD) which also leads to cardiovascular abnormalities. Previous studies showed that only few hemodialysis patients had serum calcium, phosphate and parathyroid hormone levels within the K/DOQI (Kidney-Disease Outcomes Quality Initiative) targets of 2003. Our aim was to identify the impact of different therapeutic strategies and that of the KDIGO (Kidney-Disease: Improving Global Outcomes) targets of 2009 on the control of CKD-MBD.
  
  
  METHODS
  The French calcium and phosphate observatory monitors the mineral metabolism of patients with CKD at the local, regional and national level every six months. We compared the data recorded in June 2008 (n=1914 patients) with those collected in October 2012 (n=2481) for patients aged 18 years or more, who started hemodialysis therapy within the last 12 months.
  
  
  RESULTS
  As compared with 2008, in 2012 fewer patients had hyperphosphatemia (55.1 % versus 64.7 %), hypocalcemia (35.5 % versus 40.3 %) and hyperparathyroidism (9.8 % versus 10.1 %) according to the KDIGO guideline, and more had hypophosphatemia (9.6 % versus 6.5 %), hypercalcemia (3.9 % versus 2.2 %) and hypoparathyroidism (31.5 % versus 25.8 %) (P<0.001, P<0.001 and P=0.002 respectively for differences in serum phosphate, calcium and PTH levels). Mean (± standard deviation [SD]) serum 25 OH vitamin D levels increased by 1.6-fold, from 48.3±42.6 nmol/L in 2008 to 76.6±45.8 nmol/L in 2012. Between 2008 and 2012, the prescription of native vitamin D derivatives and sevelamer (HCl or carbonate) increased whereas that of cinacalcet, lanthanum carbonate, calcium-chelating agents and active vitamin D derivatives decreased.
  
  
  CONCLUSIONS
  Despite a slight improvement of biochemical CKD-MBD parameters in the observation period only few patients reached the three KDIGO targets (11.5 % in 2012 versus 11.1 % in 2008).
authors.affiliation: Département de néphrologie, Inserm U1033, UCBL, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: solenne.pelletier@chu-lyon.fr.
authors.forename: Solenne
authors.initials: S
authors.lastname: Pelletier
authors.affiliation: Service de nutrition artificielle 7eF, hôpital Michallon, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Roth
authors.affiliation: CTMR Saint-Augustin, 106, avenue d'Ares, 33000 Bordeaux, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bouchet
authors.affiliation: Inserm U1018, CESP, hôpital Paul-Brousse, université Paris-Saclay, université Paris-Sud, UVSQ, batiment 15/16, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
authors.forename: Tilman B
authors.initials: TB
authors.lastname: Drueke
authors.affiliation: Faculté de médecine de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
authors.affiliation: Néphrocare Tassin-Charcot, 69110 Sainte-Foy-lès-Lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.affiliation: Service de néphrologie, centre hospitalier Mahnes, 8, rue Roger-Clavier, 91712 Fleury-Mérogis, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: London
authors.affiliation: Département de néphrologie, Inserm U1060, UCBL, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
mesh_terms: D000368:Aged; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D013997:Time Factors
keywords: Calcium metabolism; France; Hemodialysis; Hormone parathyroïdienne; Hémodialyse; Métabolisme calcique; Métabolisme du phosphore; Parathyroid hormone; Phosphate metabolism