Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study

Gallieni, Maurizio; Luca, Nicola De; Santoro, Domenico; Meneghel, Gina; Formica, Marco; Grandaliano, Giuseppe; Pizzarelli, Francesco; Cossu, Maria Vittoria; Segoloni, Giuseppe; Quintaliani, Giuseppe; Giulio, Salvatore Di; Pisani, Antonio; Malaguti, Moreno; Marseglia, Cosimo Damiano; Oldrizzi, Lamberto; Pacilio, Maria; Conte, Giuseppe; Canton, Antonio Dal; Minutolo, Roberto

doi:10.1007/s40620-015-0202-4

Cited by 23 publications

(16 citation statements)

References 27 publications

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“…Second, "therapeutic inertia" might have a role. The therapeutic inertia is a well described concept in patients with CKD and this phenomenon might also be in charge in our cases [24].…”

Section: Plos Onementioning

confidence: 78%

Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

et al. 2020

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Objectives Anemia is highly prevalent in chronic kidney disease patients; however, its identification and management have been reported to be suboptimal. In this study we aimed to describe the prevalence, severity, risk factors, and treatment of anemia in different nephrology centers, among chronic kidney disease patients who were not given renal replacement therapy. Materials and methods We performed a multicenter cross-sectional study in three different nephrology clinics. Adult (>18 years of age) chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started dialysis were recruited. Demographic, clinical and laboratory data regarding anemia and its management were collected using a standard data form. Anemia was defined as a hemoglobin level below 12g/dL and severe anemia as a hemoglobin level below 10g/dl. Results A total of 1066 patients were enrolled in the study. Anemia and severe anemia were present in 55.9% and 14.9% of the patients, respectively. The mean hemoglobin level for the whole cohort was 11.8±1.8 g/dL. Univariate analyses revealed that the mean hemoglobin level was significantly different among the centers. Moreover, the frequency of the presence of anemia stratified by severity was also significantly different among the centers. According to binary logistic regression analysis, gender, levels of eGFR and iron, ferritin � 100 ng/mL, and the nephrology center were independent determinants of severe anemia. Conclusions We found a high prevalence of anemia among chronic kidney disease patients who were not on renal replacement therapy. Each center should determine the treatment strategy

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“…Second, "therapeutic inertia" might have a role. The therapeutic inertia is a well described concept in patients with CKD and this phenomenon might also be in charge in our cases [24].…”

Section: Plos Onementioning

confidence: 78%

Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

et al. 2020

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“…Estimates from the Italian dialysis and transplant registry reported approximately 45,000-49,000 patients on dialysis from 2011 to 2013 [14]. In contrast, data related to the real-life clinical management and outcomes of stage 1 through 5 CKD patients not on dialysis is extremely limited, with few studies conducted in Italy [15,16]. The aim of IRIDE (Italian obseRvatIonal study on management of CKD patiEnts and related costs), a multicenter, prospective, observational study, was to describe the course of the disease and the clinical management of Italian patients with CKD over a 3-year period.…”

Section: Introductionmentioning

confidence: 99%

Clinical Management of Chronic Kidney Disease Patients in Italy: Results from the IRIDE Study

Cozzolino

Bolasco

Ronco

et al. 2018

Nephron

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Background: Lack of adequate management of chronic kidney disease (CKD) often results in delayed diagnosis and inadequate treatment. This study assessed the clinical management and outcome of stages 1–5 CKD patients. Methods: Patients were prospectively followed for 3 years in 25 nephrology centers across Italy. Clinical characteristics were measured at baseline and every 6 months. Outcome measures included CKD staging, presence of comorbidities, treatment, mineral bone disorder (MBD) parameters, and patient outcomes. Results: Of 884 enrolled patients (59.7% males, aged 66.2 ± 14.6 years), 587 (66.4%) completed the study. The majority of patients were referred by a general practitioner (44.7%) and had stage 3 or 4 CKD (40.9 and 23.8% respectively). Data reveal that 91.3% of patients had at least 1 concomitant disease, most frequently hypertension (80.1%) and dyslipidemia (42.5%); 94.6% of patients were receiving cardiovascular medication and 52.6% were receiving lipid-lowering medication. Approximately 40% of patients had proteinuria and intact parathyroid hormone levels outside the normal range. As expected, stages 4 and 5 CKD patients had a higher prevalence of proteinuria (68 and 74%), MBD (59 and 88%) and anemia (28 and 73%), as well as a higher risk of hospitalization (34.3 and 51.9%) and need for dialysis (69.5 and 70%). The overall probability of survival over 36 months was 90.6%. Conclusions: This is the first Italian prospective study performed with a large cohort of CKD patients over a 3-year period. Considering the multifactorial burden of diseases associated with CKD patients, the need for greater attention to CKD and related disorders is paramount.

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“…[ 17 18 ] The control rate of serum phosphorus in China is also comparable to those countries. [ 14 16 18 ] In contrast to a previous study of 727 predialysis CKD Stages 3b–5 patients from Italy,[ 16 ] a similar prescription rate of PBs was identified (17.3% vs. 20.1%). However, we also noticed that a higher prevalence of the patients (71.6%) with higher phosphorus level was a lack of PBs treatment in our study than that observed in Italy (50.9%).…”

Section: Discussionmentioning

confidence: 55%

“…Researches from Asian, especially Asian developing countries, are limited. Our study revealed that Chinese CKD patients had a serum phosphorus level comparable to that from the US,[ 14 15 ] Italy,[ 16 ] and Japan. [ 17 18 ] The control rate of serum phosphorus in China is also comparable to those countries.…”

Section: Discussionmentioning

confidence: 63%

Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease

Zhou

Wang

et al. 2016

Chinese Medical Journal

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Background:Mineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods:Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients’ entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.Results:Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min−1.1.73 m−2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions:In Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

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Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study

Cited by 23 publications

References 27 publications

Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor?

Clinical Management of Chronic Kidney Disease Patients in Italy: Results from the IRIDE Study

Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease

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