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Serum calcium and phosphorus levels in patients undergoing maintenance hemodialysis: A multicentre study in Korea
Gheun-Ho Kim1, Bum Soon Choi2, Dae Ryong Cha3
1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Insights
Secondary hyperparathyroidism (SHPT) in hemodialysis patients is often poorly controlled, despite guidelines. Abnormal calcium and phosphorus levels are linked to uncontrolled SHPT, highlighting the need for better management strategies.
Area of Science:
- Nephrology
- Endocrinology
- Mineral Bone Disorders
Background:
- Clinical practice guidelines for mineral bone disorders aim to control secondary hyperparathyroidism (SHPT) in hemodialysis patients.
- The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines are widely used in Korea.
- This study investigates the current control status of serum calcium (Ca) and phosphorus (P) in Korean hemodialysis patients.
Purpose of the Study:
- To assess the prevalence and control status of secondary hyperparathyroidism (SHPT) in patients undergoing maintenance hemodialysis (MHD) in Korea.
- To evaluate adherence to KDOQI guidelines for serum calcium, phosphorus, and Ca×P product levels.
- To identify associations between serum mineral levels and intact parathyroid hormone (iPTH) in MHD patients.
Main Methods:
- Retrospective analysis of serum Ca, P, and iPTH levels from 1,018 MHD patients across 17 centers.
- Average values measured over one year were analyzed.
- Patients were categorized based on iPTH levels to define controlled and uncontrolled SHPT.
Main Results:
- Average serum Ca: 9.1±0.7 mg/dL, P: 5.3±1.4 mg/dL, Ca×P product: 48.0±13.6 mg²/dL².
- Percentage of patients within KDOQI ranges: Ca 58.7%, P 51.0%, Ca×P product 70.7%.
- Uncontrolled SHPT (iPTH >300 pg/mL) was observed in 26.5% of patients; 42.7% had iPTH <150 pg/mL. Uncontrolled SHPT correlated with higher Ca, P, and Ca×P product levels.
Conclusions:
- Secondary hyperparathyroidism (SHPT) remains inadequately controlled in a significant proportion of maintenance hemodialysis (MHD) patients, despite current guidelines.
- Elevated serum calcium, phosphorus, and Ca×P product are associated with uncontrolled SHPT.
- Effective management of SHPT is crucial for improving outcomes in MHD patients.
Background:
In many countries, nephrologists follow clinical practice guidelines for mineral bone disorders to control secondary hyperparathyroidism (SHPT) associated with abnormal serum calcium (Ca) and phosphorus (P) levels in patients undergoing maintenance hemodialysis (MHD). The Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines have long been used in Korea, and this study was undertaken to investigate the current status of serum Ca and P control in MHD patients.
Methods:
Data were collected from a total of 1,018 patients undergoing MHD without intercurrent illness, in 17 hemodialysis centers throughout the country. Serum levels of Ca, P, and intact parathyroid hormone (iPTH) were measured over 1 year, and the average values were retrospectively analyzed.
Results:
Serum levels of Ca, P, and the Ca×P product were 9.1±0.7 mg/dL, 5.3±1.4 mg/dL, and 48.0±13.6 mg(2)/dL(2), respectively. However, the percentages of patients with Ca, P, and Ca × P product levels within the KDOQI guideline ranges were 58.7%, 51.0%, and 70.7%, respectively. Of the 1,018 patients, 270 (26.5%) had iPTH >300 pg/mL (uncontrolled SHPT), whereas 435 patients (42.7%) showed iPTH <150 pg/mL. Patients with uncontrolled SHPT had significantly higher values of serum Ca, P, and Ca×P product than those with iPTH ≤300 pg/mL.
Conclusion:
Despite the current clinical practice guidelines, SHPT seems to be inadequately controlled in many MHD patients. Uncontrolled SHPT was associated with higher levels of serum Ca, P, and Ca × P product, suggestive of the importance of SHPT management.
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