To what extent can we achieve mineral bone metabolism treatment targets suggested by the KDIGO guidelines among chronic kidney disease stage 3-5 non-dialysis patients?

Dincer M. T., ÖZCAN Ş. G., Alagoz S., Karaca C., Gulcicek S. H., TRABULUS S., ...More

CLINICAL NEPHROLOGY, vol.98, no.5, pp.239-246, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 98 Issue: 5
  • Publication Date: 2022
  • Doi Number: 10.5414/cn110733
  • Journal Name: CLINICAL NEPHROLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.239-246
  • Keywords: chronic kidney disease, hyperphosphatemia, overtreatment, para-thyroid hormone, thera-peutic inertia, CKD-MBD, RENAL-DISEASE, PHOSPHATE, PREVALENCE, MANAGEMENT, MORTALITY, RISK
  • Istanbul University Affiliated: Yes

Abstract

Introduction: Real-life data on the predialysis management of chronic kid-ney disease (CKD) is scarce. In this study, our aim was to investigate the current clinical practice and compliance among nephrolo-gists with the KDIGO chronic kidney dis-ease-mineral and bone disorder (CKD-MBD) guidelines. Materials and methods: In this multicenter cross-sectional study, we re-cruited stage 3 - 5 non-dialysis (ND) CKD patients and recorded the data related to CKD-MBD from two consecutive outpatient clinical visits 3 - 6 months apart. We calcu-lated the therapeutic inertia for hyperphos-phatemia, hypocalcemia, hyperparathy-roidism, and hypovitaminosis D, in addition to overtreatment for hypophosphatemia, hypercalcemia, hypoparathyroidism, and hypervitaminosis D. Results: We examined a total of 302 patients (male: 48.7%, me-dian age: 67 years). The persistence of low 25-hydroxy vitamin D levels was the most common laboratory abnormality related to CKD-MBD (61.7%), followed by hyperpara-thyroidism (14.8%), hyperphosphatemia (7.9%), and hypocalcemia (0.0%). Accord-ing to our results, therapeutic inertia seems to be a more common problem than over -treatment for all the CKD-MBD laboratory parameters that we examined. Therapeutic inertia frequency was highest for hypovita-minosis D (81.1%), followed by hypocalce-mia (75.0%), hyperparathyroidism (59.0%), and hyperphosphatemia (30.4%). Conclu-sion: We concluded that CKD-MBD is not optimally managed in CKD stage 3 - 5 ND patients. Clinicians should have an active at-titude regarding the correction of MBD even at the earlier stages of CKD.