[CA-P control in haemodialysis and K/DOQI guidelines]

Area of Science:

• Nephrology
• Mineral Metabolism
• Chronic Kidney Disease

Context:

• The K/DOQI guidelines (2003) established target serum levels for iPTH, Ca, P, and CaxP product in chronic kidney disease patients.
• Many hemodialysis patients fail to achieve these recommended targets, increasing risks.
• Assessing the percentage of patients outside target ranges is crucial for preventing bone disease and reducing mortality.

Purpose:

• To evaluate the control of calcium-phosphate (Ca-P) metabolism in hemodialysis patients.
• To determine the achievement rate of K/DOQI guideline target levels in this population.

Summary:

• A retrospective study analyzed 190 prevalent hemodialysis patients, examining serum Ca, albumin-corrected Ca, P, CaxP product, and intact parathyroid hormone (iPTH) levels.
• Results showed significant deviations from K/DOQI targets: 53.7% had normal Ca, 57.2% normal P, 71.6% normal CaxP product, and only 31.1% normal iPTH.
• Overall, only 25% of patients met all recommended mineral metabolism targets, while 17% fell outside all recommended ranges.

Impact:

• The study reveals insufficient control of mineral metabolism in hemodialysis patients, with a high percentage not meeting K/DOQI targets.
• This inadequate control exposes patients to increased risks of bone disease and cardiovascular morbimortality.
• Re-evaluating treatment adequacy based on the percentage of patients outside target ranges is essential for implementing effective therapeutic strategies.