High prevalence of biochemical disturbances of chronic kidney disease - mineral and bone disorders (CKD-MBD) in a nation-wide peritoneal dialysis cohort: are guideline goals too hard to achieve?

Abstract

Introduction: Chronic kidney disease - mineral and bone disorders (CKD-MBD) are common in dialysis patients. Definition of targets for calcium (Ca), phosphorus (P), parathormone (iPTH), and alkaline phosphatase (ALP) and their treatment recommendations, are provided by international guidelines. There are few studies analyzing CKD-MBD in peritoneal dialysis (PD) patients and the impact of guidelines on mineral metabolism control. The aim of our study was to describe the prevalence of biomarkers for CKD-MBD in a large cohort of PD patients in Brazil. Methods: Data from the nation-wide prospective observational cohort BRAZPD II was used. Incident patients were followed between December 2004 and January 2011. According to KDOQI recommendations, reference ranges for total Ca were 8.4 to 9.5 mg/dL, for P, 3.5 to 5.5 mg/dL, for iPTH, 150-300 pg/mL, and for ALP, 120 U/L. Results: Mean age was 59.8 ± 16 years, 48% were male, and 43% had diabetes. In the beginning, Ca was 8.9 ± 0.9 mg/dL, and 48.3% were on the KODQI target. After 1 year, Ca increased to 9.1 ± 0.9 mg/dL and 50.4% were in the KDOQI preferred range. P at baseline was 5.2 ± 1.6 mg/dL, with 52.8% on target, declining to 4.9 ± 1.5 mg/dL after one year, when 54.7% were on target. Median iPTH at baseline was 238 (P25% 110 - P75% 426 pg/mL) and it remained stable throughout the first year; patients within target ranged from 26 to 28.5%. At the end of the study, 80% was in 3.5 meq/L Ca dialysate concentration, 66.9% of patients was taking any phosphate binder, and 25% was taking activated vitamin D. Conclusions: We observed a significant prevalence of biochemical disorders related to CKD-MBD in this dialysis population.

A feasibility study of avoiding positive calcium balance and parathyroid hormone increase in patients on peritoneal dialysis

“…Data from the Dialysis Practice Patterns and Results Study (DOPPS) show there is still a considerable percentage of patients on PD receiving dialysis with d[Ca] of 1.75 mmol/L ( Wang et al, 2019 ), which is also true for Brazil ( Weissheimer et al, 2021 ), despite the recommendation of a d[Ca] between 1.25 and 1.50 mmol/L ( Uhlig et al, 2010 ; C.K.D.M.B.D.W.G, 2009 ). Knowing the risks of a positive calcium balance for patients with advanced CKD ( Elias et al, 2021 ), the results from our study should encourage a spread use of recommended d[Ca] from 1.25 to 1.5 mEq/L.…”

Low serum vitamin D concentration is correlated with anemia, microinflammation, and oxidative stress in patients with peritoneal dialysis

“…Third, the effects of the supplementation of vitamin D on anemia, oxidative stress and microinflammatory state in PD patients should be explored in future work. Although vitamin D has been used in the treatment of PD patients, vitamin D toxicity is a potential risk [ 32 , 33 ]. Several studies have investigated the influence of vitamin D3 supplementation on serum 25(OH)D concentration and indicated the safe dose of vitamin D3 ranging from 5000 to 50,000 IUs/day [ 34 – 36 ].…”

BMD in peritoneal dialysis: what BRAZPD can help us understand?

“…(CKD-MBD) in a nation-wide peritoneal dialysis cohort: are guideline goals too hard to achieve?" 1 This paper, with a patient follow-up of 12 months, made it possible to show the prevalence of metabolic changes in PD patients, which were similar to those of patients on hemodialysis (HD). Regarding the percentage of patients who reached the goals established by the KDOQI, the current guideline at the time, there was a small variation between the beginning and the end of the study.…”