Control of mineral metabolism and bone disease in haemodialysis patients: which optimal targets?

Fouque, Denis; Roth, Hubert; Pelletier, Solenne; London, Gérard M.; Hannedouche, Thierry; Gadrey, Jean; Bouchet, Jean-Louis; Drüeke, Tilman B.

doi:10.1093/ndt/gfs404

Cited by 75 publications

(100 citation statements)

References 31 publications

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“…However, guideline development does not guarantee its clinical use. For nephrologists, clinical guidelines are important tools for making professional decisions; however, the value of these guidelines is diminished when they fail to be properly applied [17,28,29]. It is important to make sure that the guidelines used are applicable to the region.…”

Section: Discussionmentioning

confidence: 99%

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

Palomares

Ramos²,

Martín‐Malo³

et al. 2013

Blood Purif

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Background: To standardize therapy and improve the clinical outcome for chronic haemodialysis (HD) patients, guidelines have been developed for mineral metabolism management. We evaluated compliance with different mineral metabolism guidelines. Methods: 2,951 chronic HD patients from 61 dialysis centres in Spain were studied. Mineral metabolism management data from a 1-year period were analysed according to KDOQI, KDIGO, and Spanish guidelines. Results: Only 1% (KDOQI), 6% (KDIGO) and 11% (Spanish guidelines) of patients continuously achieved total calcium (Ca), phosphate (P) and parathyroid hormone (PTH) target-range values during the year with higher percentages if we considered the 1-year average. The yearly Ca, P and iPTH average accomplished Spanish guidelines with different percentage among centres: CA 62-100%, P 59-91%, PTH 61-89%, and 28-77% considering all three targets together. The KDIGO guidelines recommend similar percentages except for P (33-77%). No differences were found related to eKt/V, online haemodiafiltration/HD, weight, body mass index, or dialysis vintage. They were only related to age, blood flow, effective treatment time, and dialysate calcium but without relevant clinical differences. Patients outside the target ranges generated significantly higher treatment costs. Conclusions: Compliance with mineral metabolism targets in HD patients was poor and showed a wide variation between treatment centres.

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Section: Discussionmentioning

confidence: 99%

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

Palomares

Ramos²,

Martín‐Malo³

et al. 2013

Blood Purif

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“…In patients with CKD receiving dialysis who were administered cinacalcet, 29% of those in the 6-month registration trials and 21% and 33% of those (within the first 6 months and overall, respectively) in the EVOLVE clinical trial had at least one serum Ca value ,7.5 mg/dl (13). A continuous risk analysis showed a 10% increase in HR for mortality for a noncorrected serum Ca as low as ,6.37 mg/dl but also for serum Ca .9.66 mg/dl (82).…”

Section: Hypocalcemiamentioning

confidence: 97%

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

Bover

Ureña

Ruiz-García

et al. 2016

Clinical Journal of the American Society of Nephrology

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CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD-related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.

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“…For example, many high-protein foods are rich in phosphorus, leading to hyperphosphatemia, which has been associated with renal bone disease, cardiovascular disease including vascular calcification and higher mortality risk [6][7][8][9][10][11]. As such, hemodialysis patients are frequently counseled on dietary phosphorus restriction, which may inadvertently lead to a reduction in protein intake [8,12,13].…”

Section: Introductionmentioning

confidence: 99%

Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: findings from the FrEDI randomized controlled trial

Rhee

You

Parsons

et al. 2016

Nephrol. Dial. Transplant.

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Control of mineral metabolism and bone disease in haemodialysis patients: which optimal targets?

Cited by 75 publications

References 31 publications

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

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

Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: findings from the FrEDI randomized controlled trial

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