title: Multinational observational study on clinical practices and therapeutic management of mineral and bone disorders in patients with chronic kidney disease stages 4, 5, and 5D: The OCEANOS study.
abstract: Our aim is to assess the current clinical practices in monitoring and treatment patterns of chronic kidney disease (CKD)-mineral bone disorder and the degree to which these practices met the kidney disease improving global outcome (KDIGO) guidelines. This was an international, multi-center, cross-sectional, observational study in adult patients diagnosed with CKD Stages 4, 5, and 5D. Patients were enrolled from Middle East, South Asia, Eurasia, and Africa; patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) or with any medical/surgical conditions precluding their participation were excluded. Frequency of measurements, levels of serum calcium (Ca), phosphorus and parathormone (parathyroid hormone [PTH], and presence vascular/valvular calcification were recorded. Of the 2250 patients enrolled, data on 2247 patients were evaluated. Overall, only a small percentage of patients met all three target KDIGO ranges of serum Ca, phosphorus, and PTH (13.7% [95% confidence interval: 12.0; 15.4], with a higher proportion among CKD Stage 5D patients (14.8%) than CKD Stage 4 and 5 (5.6%) patients. Majority (84.3%) of the patients received treatment with phosphorous binders, of whom 85.5% received Ca-based phosphate binders. Overall, 57.0% of patients received Vitamin D treatment with a similar frequency among patients with CKD Stages 4, 5, and 5D. Over half (65.7%) of the patients were screened for vascular/valvular calcification; of these, 58.8% had ≥1 calcification. Diabetes status, P, PTH, and low density lipoprotein-cholesterol had significant impact on the prescription pattern of phosphorous binders. The current practices for the management of bone and mineral metabolism in CKD patients in the study region fall far short of meeting the KDIGO target range.
authors.affiliation: Saudi Center for Organ Transplantation, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Faissal A M
authors.initials: FA
authors.lastname: Shaheen
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Kurpad
authors.forename: Abdulla A
authors.initials: AA
authors.lastname: Al-Sayyari
authors.forename: Muhammad Ziad
authors.initials: MZ
authors.lastname: Souqiyyeh
authors.forename: Harith
authors.initials: H
authors.lastname: Aljubori
authors.forename: Tarek
authors.initials: T
authors.lastname: El Baz
authors.forename: Waqaruddin
authors.initials: W
authors.lastname: Kashif
authors.forename: Saltanat
authors.initials: S
authors.lastname: Tuganbekova
authors.forename: Kairat
authors.initials: K
authors.lastname: Kabulbayev
authors.forename: Faical
authors.initials: F
authors.lastname: Jarraya
authors.forename: Mohsen
authors.initials: M
authors.lastname: Nafar
mesh_terms: D000328:Adult; D000349:Africa; D015415:Biomarkers / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use; D019587:Dietary Supplements; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East; D009398:Nephrology / Q000592:standards*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; C470125:PTH protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium