Compliance with objectives based on different guidelines (KDIGO/S.E.N.) and analysis of the individual variability of mineral metabolism in haemodialysis patients in the medium term

• Published in: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia Vol. 33; no. 5; p. 675
• Main Authors: del Pozo-Fernández, Carlos, López-Menchero-Martínez, Ramón, Álvarez-Avellán, Luis, Albero-Molina, M Dolores, Sánchez-Rodríguez, Laura
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 2013
• Subjects: Aged; Calcium - blood; Chelating Agents - therapeutic use; Chronic Kidney Disease-Mineral and Bone Disorder - blood; Chronic Kidney Disease-Mineral and Bone Disorder - etiology; Cinacalcet Hydrochloride; Ergocalciferols - administration & dosage; Ergocalciferols - therapeutic use; Female; Follow-Up Studies; Goals; Guideline Adherence; Humans; Hyperparathyroidism, Secondary - blood; Hyperparathyroidism, Secondary - etiology; Hyperparathyroidism, Secondary - prevention & control; Hyperparathyroidism, Secondary - surgery; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - therapy; Kidney Transplantation; Male; Middle Aged; Naphthalenes - administration & dosage; Naphthalenes - therapeutic use; Parathyroid Hormone - blood; Parathyroidectomy; Peritoneal Dialysis; Phosphorus - blood; Postoperative Complications - blood; Postoperative Complications - therapy; Practice Guidelines as Topic; Renal Dialysis - standards; Retrospective Studies
• ISSN: 1989-2284
• DOI: 10.3265/Nefrologia.pre2013.Jun.11980

To assess the level of compliance and variability of mineral metabolism parameters over time in a sample of haemodialysis patients for the different ranges proposed (KDIGO guidelines/S.E.N recommendations) in both groups and individuals continuously.
Every four months, we collected data on calcium, phosphorus, PTH and treatment in a sample of 44 patients followed up continuously for 32 months. We established the percentages of patients who complied with the objectives set for each parameter in both ranges: optimal (KDIGO) and acceptable (S.E.N.) in each control and the percentage that individually complied with the objectives in at least 75% of the determinations.
Compliance with the objective using the optimal range improved, although PTH did not exceed 50%. Using the acceptable range, the objective was achieved in the three parameters in over 70% and over 50% of patients achieved the three simultaneously while using the optimal range, 30% was never achieved. Individually, compliance with the optimal range was continuously achieved in 52.3% (calcium), 45.5% (phosphorus) and in only one patient in PTH, while when using the acceptable range, compliance was achieved in 84.1% (calcium) and 70.5% (phosphorus and PTH).
The use of less stringent criteria than the KDIGO guidelines in calcium, phosphorus and PTH objectives allows patients to remain continuously within appropriate ranges with less intervention and less individual variability.