Achievements in CKD-MBD guidelines targets: is there a progress in the implementation practice?

Area of Science:

• Nephrology
• Internal Medicine
• Public Health

Background:

• Guidelines aim to standardize nephrologist practices for better patient outcomes.
• Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) KDOQI guidelines address management complexities.
• Variability in CKD-MBD treatment strategies necessitates monitoring guideline implementation.

Purpose of the Study:

• To assess CKD-MBD KDOQI guideline implementation in Macedonian dialysis units in 2009.
• To analyze treatment strategies and identify shortcomings in guideline adherence.
• To compare 2009 findings with a previous 2005 survey to identify trends.

Main Methods:

• A national survey using questionnaires distributed to all dialysis units in 2009.
• Inclusion of 742 dialysis patients, with data comparable to 588 patients from a 2005 survey.
• Collection of mean biochemical parameters (calcium, phosphate, iPTH) and treatment data (dialysate calcium, phosphate binders, vitamin D).

Main Results:

• Most patients achieved target ranges for calcium and phosphate, but not iPTH (<150 pg/ml).
• Significant improvements in biochemical parameter control were observed in 2009 compared to 2005.
• Increased adherence to serum calcium targets (79% vs. 67.4%) and reduced calcium carbonate dosage were noted.

Conclusions:

• CKD-MBD KDOQI guidelines led to improved bone and mineral parameter control in dialysis units.
• Optimizing iPTH levels requires greater use of low calcium dialysate (1.25 mmol/L) and non-calcium-based phosphate binders.
• Continuous monitoring and periodic surveys are crucial for effective guideline implementation and management individualization.