title: Association between Hemodialysis Patient Outcomes and Compliance with KDOQI and KDIGO Targets for Mineral and Bone Metabolism.
abstract: BACKGROUND
  Increased mortality of hemodialysis (HD) patients is associated with chronic kidney disease-mineral and bone disorders (CKD-MBD), and therefore, their correction may improve patient survival. Differences in targets recommended by KDOQI and KDIGO CKD-MBD guidelines directed us to compare the relative numbers of patients achieving these targets and to examine possible associations between compliance with the targets and patient outcome.
  
  
  METHODS
  A total of 1,744 patients (61.2% males, aged 58.7 ± 12.5 years) dialyzed in 20 HD centers in Serbia were monitored for 3 years. The number of participants achieving KDOQI/KDIGO guideline targets for serum phosphorus, calcium, and iPTH was determined. The Cox proportional hazards model was used to select variables significantly associated with risk of time to death.
  
  
  RESULTS
  A majority of patients were dialyzed thrice weekly for 4 h; 86.3% of them used phosphate binders and 49.3% vitamin D3. Proportions of patients achieving KDOQI and KDIGO targets were 49.5 and 44.4% for phosphorus, 53.2 and 76.7% for calcium, 21 and 42.8% for iPTH. Multivariate Cox analysis selected serum phosphorus level outside the KDIGO target, as well as serum iPTH levels outside KDOQI and KDIGO targets as significant mortality predictors. Areas under the receiver operating characteristic curves showed that achievement of both guideline targets for iPTH had similar survival predictive values.
  
  
  CONCLUSIONS
  Serum phosphorus levels outside KDIGO targets and iPTH levels outside both KDOQI and KDIGO targets were associated with a significantly higher risk of death. These findings may be useful in the management of CKD-MBD and for establishing local guidelines.
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Ljubica
authors.initials: L
authors.lastname: Djukanović
authors.forename: Nada
authors.initials: N
authors.lastname: Dimković
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinković
authors.forename: Živka
authors.initials: Ž
authors.lastname: Djurić
authors.forename: Violeta
authors.initials: V
authors.lastname: Knežević
authors.forename: Tatjana
authors.initials: T
authors.lastname: Lazarević
authors.forename: Stanimir
authors.initials: S
authors.lastname: Ljubenović
authors.forename: Rodoljub
authors.initials: R
authors.lastname: Marković
authors.forename: Violeta
authors.initials: V
authors.lastname: Rabrenović
mesh_terms: D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D005260:Female; D006040:Goals; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D055771:Serbia / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium