Compliance with Mineral Metabolism Targets in Haemodialysis Patients: Moving Backwards?

Palomares, Inés; Ramos, Rosa; Martín‐Malo, Alejandro; Merello, José Ignacio; Praga, Manuel; Luño, José; Francisco, Ángel; Nil, A.L.M.

doi:10.1159/000353418

Cited by 7 publications

(4 citation statements)

References 52 publications

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“…This study found that PTH was positively associated with dialysis vintage ( Fig 3 and Table 3 ); this is not an unusual finding since there are reports showing that hyperparathyroidism progresses with time on dialysis until the patient becomes older. Age, is known to be negatively associated with PTH and with a tendency to adynamic bone disease [ 10 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

A New Data Analysis System to Quantify Associations between Biochemical Parameters of Chronic Kidney Disease-Mineral Bone Disease

et al. 2016

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BackgroundIn hemodialysis patients, deviations from KDIGO recommended values of individual parameters, phosphate, calcium or parathyroid hormone (PTH), are associated with increased mortality. However, it is widely accepted that these parameters are not regulated independently of each other and that therapy aimed to correct one parameter often modifies the others. The aim of the present study is to quantify the degree of association between parameters of chronic kidney disease and mineral bone disease (CKD-MBD).MethodsData was extracted from a cohort of 1758 adult HD patients between January 2000 and June 2013 obtaining a total of 46.141 records (10 year follow-up). We used an advanced data analysis system called Random Forest (RF) which is based on self-learning procedure with similar axioms to those utilized for the development of artificial intelligence. This new approach is particularly useful when the variables analyzed are closely dependent to each other.ResultsThe analysis revealed a strong association between PTH and phosphate that was superior to that of PTH and Calcium. The classical linear regression analysis between PTH and phosphate shows a correlation coefficient is 0.27, p<0.001, the possibility to predict PTH changes from phosphate modification is marginal. Alternatively, RF assumes that changes in phosphate will cause modifications in other associated variables (calcium and others) that may also affect PTH values. Using RF the correlation coefficient between changes in serum PTH and phosphate is 0.77, p<0.001; thus, the power of prediction is markedly increased. The effect of therapy on biochemical variables was also analyzed using this RF.ConclusionOur results suggest that the analysis of the complex interactions between mineral metabolism parameters in CKD-MBD may demand a more advanced data analysis system such as RF.

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Section: Discussionmentioning

confidence: 99%

A New Data Analysis System to Quantify Associations between Biochemical Parameters of Chronic Kidney Disease-Mineral Bone Disease

et al. 2016

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“…Adherence to the recommended target ranges slightly increased after dialysis onset, but nearly 85% of the patients failed to attain the three main KDIGO targets 2 years later. However, compliance with MBD targets seems higher in France than in Spain, where only 6% of the patients consistently achieved the three main KDIGO targets over a 1-year follow-up period [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Achievement of Kidney Disease: Improving Global Outcomes mineral and bone targets between 2010 and 2014 in incident dialysis patients in France: the Photo-Graphe3 study

Fouque

Roth

Darné

et al. 2017

Clinical Kidney Journal

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BackgroundAbnormal serum phosphate, calcium and parathyroid hormone (PTH) levels in patients with chronic kidney disease (CKD) undergoing haemodialysis have been associated with poor survival. The French Phosphorus and Calcium Observatory (Photo-Graphe® 3) aimed to estimate the percentage of CKD patients achieving the three Kidney Disease: Improving Global Outcomes (KDIGO) targets about optimal serum phosphate, calcium and PTH over a 3.5-year follow-up period.MethodsThis was a prospective, multicentre, epidemiological observational study conducted with nephrologists in France, selected using a clustering approach. Eligible patients were adults undergoing intermittent haemodialysis or haemodiafiltration therapy started within the preceding 12 months. Data about clinical events, serum biochemistry and treatment were collected once every 6 months for 2.5 years and 12 months thereafter.ResultsOverall, 9010 incident patients were included (men, 63%; median age, 71 years) of whom 7515 (83.4%) were treated by haemodialysis and 1495 (16.6%) by haemodiafiltration. None had a history of fracture or revascularization while 89 (1%) patients had a history of parathyroidectomy >6 months. Overall, 874 (10%) patients received a kidney graft, 2183 (24%) died and 1148 (13%) were lost to follow-up. The proportion achieving the three KDIGO targets increased significantly from 11% to 16% (P < 0.0001) until Year 2, but remained stable afterwards. The percentage of incident dialysis patients with normal serum phosphate (P < 0.0001) or normal serum calcium (P < 0.0001) levels increased significantly over time, while no significant change was observed for those with controlled PTH.ConclusionLess than 20% of patients achieved the KDIGO recommendations although their proportion increased slightly over time.

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“…In the current issue, Palomares et al [1] lament the poor compliance with various guideline targets for mineral metabolism in hemodialysis patients. I suggest this is welcome news.…”

Section: Figmentioning

confidence: 99%

Guideline Bone Disease

Amerling

2013

Blood Purif

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In the current issue of Blood Purification, Palomares et al. [Blood Purif 2013;36:122-131] bemoan the poor level of compliance in dialysis units in achieving compliance with KDOQI and KDIGO bone and mineral guideline targets. These targets are based almost completely on observational data and rely on an obsolete assay for PTH. The so-called intact PTH assay measures both 1-84 PTH and 7-84 PTH; the latter has been demonstrated to possess biological activity that is antagonistic to that of 1-84 PTH. The assay cannot reliably distinguish high from low bone turnover in the target ranges suggested by the guideline panels. Targeting these ranges leads to an increased incidence of adynamic bone disease, higher calcium and phosphorus, and likely poor patient outcomes.

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Compliance with Mineral Metabolism Targets in Haemodialysis Patients: Moving Backwards?

Cited by 7 publications

References 52 publications

A New Data Analysis System to Quantify Associations between Biochemical Parameters of Chronic Kidney Disease-Mineral Bone Disease

A New Data Analysis System to Quantify Associations between Biochemical Parameters of Chronic Kidney Disease-Mineral Bone Disease

Achievement of Kidney Disease: Improving Global Outcomes mineral and bone targets between 2010 and 2014 in incident dialysis patients in France: the Photo-Graphe3 study

Guideline Bone Disease

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