Achievement of NKF/K-DOQI Recommended Target Values for Bone and Mineral Metabolism in Incident Hemodialysis Patients: Results of the FARO-2 Cohort

Abstract

Background: Mineral Bone Disorders (MBD) is prevalent in hemodialysis (HD) patients and associated with increased cardiovascular mortality. The FARO-2 study evaluated the achievement of the NKF/K-DOQI guidelines on recommended target values for serum calcium (Ca), phosphorous (P) and intact parathyroid hormone (PTH) levels on survival in incident HD patients. Methods: Data were collected by questionnaire from 568 incident HD patients followed prospectively over a 3-year period from 26 Italian dialysis units. The cumulative probability of time-to-death for CKD-MBD treatment characteristics was determined by the Kaplan-Meier curves. Results: Serum PTH levels (median values at 6 months vs. 36 months; 225 vs. 254 pg/ml), Ca (8.8 vs. 8.9 g/dl) and P (5.1 vs. 4.8 mg/dl) were not significantly different at 6 months versus follow-up. The majority of incident HD patients (60-70%) who were followed up for 36 months did not achieve the NKF/K-DOQI recommended target values. Survival rates were higher in patients on target for three parameters versus patients off target (survival at 24 months: at target 95.7% (95% CI: 84.0-98.9) versus not on target 71.1% (95% CI: 66.3-75.4, p < 0.01)). The 30.1% of patients on target for three MBD parameters at least once during the follow-up period had better survival rates compared to those not reaching these targets (survival at 24 months: at least once 88.0% (95% CI: 81.9-92.1); 67.7% (95% CI: 61.9-72.8, p < 0.01)). Conclusion: Our findings indicate that incident HD patients who achieved target levels (for three MBD parameters) for at least one visit have a lower risk of mortality.

Association between Extreme Values of Markers of Chronic Kidney Disease: Mineral and Bone Disorder and 5-Year Mortality among Prevalent Hemodialysis Patients

“…For example, the target ranges of Ca and P levels achieved may vary, depending on the dose and type of P-binder and active vitamin D used [9]. In addition, previous studies showed that even though the appropriate treatment guidelines were followed, the rates at which target range levels were achieved were quite low in the long term [10,11,12]. For example, in the FARO-2 study, only 8% of patients were able to achieve Kidney Disease Outcomes Quality Initiative targets for all 3 bone and mineral metabolism markers [12].…”

“…In addition, previous studies showed that even though the appropriate treatment guidelines were followed, the rates at which target range levels were achieved were quite low in the long term [10,11,12]. For example, in the FARO-2 study, only 8% of patients were able to achieve Kidney Disease Outcomes Quality Initiative targets for all 3 bone and mineral metabolism markers [12]. Further, in the DOPP study, the levels of all 4 markers - serum P, albumin-corrected Ca, Ca-P product, and intact parathyroid hormone (iPTH) - were within range only in 4.6-5.5% patients, while the levels of at least 3 markers reduced to within the guideline ranges in 23-28% patients [10].…”

Changes in Markers of Mineral and Bone Disorders and Mortality in Incident Hemodialysis Patients

“…[20,21] In addition, one study found that patients who achieved recommended ranges for a shorter duration of time had a higher risk of death. [20] Our results were conceptually in line with these studies.…”

International and Racial Differences in Mineral and Bone Disorder Markers and Treatments Over the First 5 Years of Hemodialysis in the Dialysis Outcomes and Practice Patterns Study

“…1,2 Findings from several studies suggest mineral and bone disorder (MBD) management to be insufficient regardless of sex, race, vintage, or nationality where less than half the patients achieve all nationally recommended MBD target values. 3,4 This is likely because MBD management is complex, requiring the interdependent titration of phosphate binders, active vitamin D, and cinacalcet to achieve pharmacotherapeutic equilibrium. Furthermore, patient characteristics, diet, and environmental factors additionally complicate the response to therapy and the achievement of therapeutic targets.…”