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Current management of secondary hyperparathyroidism: a multicenter observational study (COSMOS)
Jorge B Cannata-Andía1, José Luis Fernández-Martín, Carmine Zoccali
1Servicio de Metabolismo Oseo y Mineral, Instituto Reina Sofía de Investigación, Hospital Universitario Central de Asturias, Oveido, Spain. cannata@hca.es
Journal of Nephrology
|July 1, 2008
Summary
This study assessed bone mineral disturbances in European hemodialysis patients, evaluating Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline adherence and its impact on mortality and cardiovascular events.
Area of Science:
- Nephrology
- Bone Metabolism
- Cardiovascular Health
Background:
- Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis (HD) patients.
- Bone and mineral disturbances significantly impact patient outcomes.
Purpose of the Study:
- To survey bone mineral disturbances and SHPT management in European HD patients.
- To estimate K/DOQI guideline achievement and its association with mortality and cardiovascular events.
- To characterize longitudinal changes in bone mineral markers and their predictors.
Main Methods:
- Survey of bone mineral disturbances and clinical practices in European HD patients.
- Estimation of K/DOQI guideline achievement in a representative sample.
- Analysis of associations between bone mineral markers, mortality, and cardiovascular hospitalizations.
Main Results:
- Prevalence of K/DOQI guideline achievement varied across different patient subgroups and dialysis types.
- Bone mineral markers, particularly parathyroid hormone (PTH), calcium (Ca), serum phosphorus (P), and calcium-x-phosphorus product (CaxP), were associated with mortality and cardiovascular events.
- Longitudinal analysis revealed patterns and predictors of bone mineral marker changes over time.
Conclusions:
- Adherence to K/DOQI guidelines for bone and mineral metabolism in HD patients remains a challenge in Europe.
- Bone mineral marker levels are critical predictors of adverse outcomes in hemodialysis.
- Further research is needed to optimize SHPT management and improve patient prognosis.
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