Application of NKF-K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease: changes of clinical practices and their effects on outcomes and quality standards in three haemodialysis units

Arenas, María Dolores; Álvarez-Ude, F; Gil, María Teresa Nevado; Soriano, Antonio; Segura-Egea, Juan José; Millán, Isabel; Amoedo, Maria Luisa; Muray, S; Carretón, Maria Antonia

doi:10.1093/ndt/gfl006

Cited by 61 publications

(46 citation statements)

References 16 publications

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“…Most concerning was that only 5 to 7.3% of dialysis patients simultaneously met all four targets (PTH, Ca, P, and Ca ϫ P). According to one study that evaluated target achievement both before and after the KDOQI treatment guidelines were introduced, a majority of patients remained outside at least some of the target ranges even after implementation (6.6 and 10.9% met all for targets in 2003 and 2004, respectively) (12). Another study evaluated the effects of guideline-induced changes in non-calcium-containing phosphate binders, vitamin D use, and dialysate calcium levels and found that serum P and serum PTH levels increased in association with a modest reduction in serum Ca (14).…”

mentioning

confidence: 99%

Consistent Control of Mineral and Bone Disorder in Incident Hemodialysis Patients

Danese¹,

Belozeroff²,

Smirnakis³

et al. 2008

Clinical Journal of the American Society of Nephrology

134

104

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Results: In the simultaneous control analysis, patients who achieved target for none of the markers had a 51% greater risk for death than those who achieved target for all three markers (reference group). Patients who achieved any target for any single marker had a 35 to 39% higher risk for death, and patients who achieved target for any two of the three markers had a 15 to 21% higher risk for death compared with the reference group. In the time in target analysis, patients with parathyroid hormone in target for 4 quarters had a 25% lower risk for death compared with those who did so for <1 quarter (reference group). Patients with calcium in target for 4 quarters had a 14% lower risk, and patients with phosphorus in target for 4 quarters had a 38% lower risk.Conclusions: Consistent control of the markers of bone metabolism and disease within published targets is a strong predictor of survival in hemodialysis patients.

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mentioning

confidence: 99%

Consistent Control of Mineral and Bone Disorder in Incident Hemodialysis Patients

Danese¹,

Belozeroff²,

Smirnakis³

et al. 2008

Clinical Journal of the American Society of Nephrology

134

104

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“…18 However, it is difficult to fulfill all guideline targets simultaneously. 19 This may be particularly true for patients with SHPT who are resistant to calcitriol treatment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerability of Intravenous Paricalcitol in Calcitriol-Resistant Hemodialysis Patients with Secondary Hyperparathyroidism: 12-Month Prospective Study

et al. 2012

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Rationale/objectives: Data are limited regarding the use of paricalcitol in calcitriol-resistant patients with secondary hyperparathyroidism (SHPT). We aimed to evaluate the effects of paricalcitol in calcitriol-resistant hemodialysis patients with SHPT. Methods: This is a 12-month, open-label, prospective study. Forty patients with calcitriol-resistant and/or calcitriol-intolerant SHPT were included. After a washout period, all patients converted to paricalcitol with a 1:3 conversion ratio. Serum calcium and phosphorus were monitored monthly, while serum intact parathyroid hormone (iPTH) once in every 3 months. Paricalcitol dose was reduced or discontinued in case of hypercalcemia and/or hyperphosphatemia. Pre-and posttreatment electrolyte and iPTH values were compared with Student's t-test and Wilcoxon signed-rank test, respectively. Main findings: Forty patients completed the study. Mean initiation dose of paricalcitol was 23 ± 7 µg/week. Mean serum calcium was 8.9 ± 0.8 mg/dL at baseline and 9.4 ± 0.7 mg/dL at study end (p = 0.07). Mean monthly serum phosphorus levels stayed stable. Paricalcitol was effective in reducing iPTH levels when compared with pretreatment values (747.9 ± 497.2 pg/mL, 307.3 ± 417.1 pg/mL, respectively; p < 0.001). Thirty-two patients had to discontinue intravenous (IV) paricalcitol at some time during their treatment. Main reasons for discontinuation were as follows: hyperphosphatemia (58%), hypercalcemia (25%), and iPTH < 150 pg/mL (17%). Principle conclusions: Paricalcitol was found to be effective in reducing iPTH levels in calcitriol-resistant patients with SHPT despite relatively frequent drug discontinuation rates.

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“…29 The consistent achievement of KDOQI goals for bone and mineral metabolism has been difficult with standard therapy, with a large proportion of patients exhibiting persistent and refractory SHPT. [30][31][32][33] Not surprisingly, only about 6.6% and 10.9% of dialysis patients simultaneously met KDOQI targets for PTH, phosphorus, calcium, and calcium-phosphorus product levels in 2003 and 2004, respectively. 32 Presumably, this is related to the fact that attempts to suppress serum PTH with increasing doses of active vitamin D analogues are limited by the development of hypercalcemia and worsening hyperphosphatemia.…”

Section: Safety Profilementioning

confidence: 99%

“…[30][31][32][33] Not surprisingly, only about 6.6% and 10.9% of dialysis patients simultaneously met KDOQI targets for PTH, phosphorus, calcium, and calcium-phosphorus product levels in 2003 and 2004, respectively. 32 Presumably, this is related to the fact that attempts to suppress serum PTH with increasing doses of active vitamin D analogues are limited by the development of hypercalcemia and worsening hyperphosphatemia. 33 The likelihood of developing hypercalcemia with active Vitamin D analogues is further increased by the concomitant use of calcium-containing phosphate binders.…”

Section: Safety Profilementioning

confidence: 99%

Review of cinacalcet hydrochloride in the management of secondary hyperparathyroidism

Yousaf

Charytan

2013

Renal Failure

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Cinacalcet is the first Food and Drug Administration-approved calcimimetic for the treatment of secondary hyperparathyroidism in dialysis patients. It is effective in improving control of parathyroid hormone, serum calcium, phosphorus, and calcium-phosphorus product. The calcium-lowering effect of cinacalcet overcomes the limitations of standard therapy associated hypercalcemia. There is evidence to suggest that cinacalcet has important clinical implications, which extend beyond its relevance in the treatment of secondary hyperparathyroidism. This review summarizes the evidence regarding the role of cinacalcet in the treatment of secondary hyperparathyroidism, disrupted bone mineral metabolism, cardiovascular disease, and mortality. In addition, the cost implications of cinacalcet are briefly explored.

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Application of NKF-K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease: changes of clinical practices and their effects on outcomes and quality standards in three haemodialysis units

Cited by 61 publications

References 16 publications

Consistent Control of Mineral and Bone Disorder in Incident Hemodialysis Patients

Consistent Control of Mineral and Bone Disorder in Incident Hemodialysis Patients

Efficacy and Tolerability of Intravenous Paricalcitol in Calcitriol-Resistant Hemodialysis Patients with Secondary Hyperparathyroidism: 12-Month Prospective Study

Review of cinacalcet hydrochloride in the management of secondary hyperparathyroidism

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