Compliance with mineral metabolism targets in haemodialysis patients: moving backwards?

Area of Science:

• Nephrology
• Clinical Medicine
• Mineral Metabolism

Background:

• Established guidelines exist for mineral metabolism management in chronic haemodialysis (HD) patients.
• These guidelines aim to standardize therapy and improve clinical outcomes.
• Compliance with these guidelines is crucial for effective patient care.

Purpose of the Study:

• To evaluate the compliance of dialysis centers with different mineral metabolism guidelines.
• To assess the achievement of target ranges for calcium, phosphate, and parathyroid hormone in HD patients.
• To identify factors influencing compliance and the economic impact of non-compliance.

Main Methods:

• A retrospective analysis of mineral metabolism data from 2,951 chronic HD patients across 61 dialysis centers in Spain.
• Data were collected over a 1-year period and analyzed according to KDOQI, KDIGO, and Spanish guidelines.
• Patient characteristics and treatment parameters were assessed for correlation with guideline compliance.

Main Results:

• Continuous achievement of calcium (Ca), phosphate (P), and parathyroid hormone (PTH) target ranges was low: 1% (KDOQI), 6% (KDIGO), and 11% (Spanish guidelines).
• Average yearly achievement varied by center, with Spanish guidelines showing 62-100% for Ca, 59-91% for P, and 61-89% for PTH.
• No significant differences in compliance were linked to dialysis modality, eKt/V, or dialysis vintage, but age and treatment parameters showed some correlation. Patients outside target ranges incurred higher treatment costs.

Conclusions:

• Compliance with mineral metabolism targets in chronic haemodialysis patients is generally poor.
• There is substantial variation in guideline adherence among different dialysis treatment centers.
• Non-compliance is associated with increased healthcare costs, highlighting the need for improved management strategies.