Hypertension and nephrology

[Guidelines and clinical practice: clinical audit of CKD-MBD in Hungarian dialyzed patients]

KISS István, KISS Zoltán, SZABÓ András, SZEGEDI János, BALLA József, LADÁNYI Erzsébet, CSIKY Botond, ÁRKOSSY Ottó, TÖRÖK Marietta, TÚRI Sándor, KULCSÁR Imre

FEBRUARY 20, 2012

Hypertension and nephrology - 2012;16(01)

[Patients suffering from chronic kidney disease reach the end-stage renal disease in ever growing numbers and this necessitates the start of their dialysis treatment. The alteration of bone and mineral metabolism together with the development of the consequent organ damages starts in early stages of the chronic kidney disease. The goal of our present trial was to survey the alterations or characteristics (laboratory results, concomitant diseases and treatment practice in Hungary) of the calcium (Ca) and phosphate (PO4) metabolisms [mineral-bone disorder occurring in chronic kidney disease (CKD-MBD) or formerly known as secunder hyperparathyreosis or renal ostedistrophy] in patients chronically treated with dialysis. We collected and analyzed data/results from 5334 chronically dialyzed patients. We categorized the patients into different groups according to the guidelines of CKD-MBD so basically by the level of serum calcium and parathormone (PTH) (se-Ca level is below or above 2.4 mmol/l; PHT level is below 65 pg/ml, between 65-150, 150-300, 300-500, 500-800 pg/ml or above 800 pg/ml) and then the characteristic variances were compared. The two most frequent primary causes of end-stage renal disease are hypertension (23%) and diabetes mellitus (22%). Serum calcium level was below the upper limit of the normal range (Ca <2.4 mmol/l) in the greatest proportion of our patients (n=4386), while the parathormone level was elevated (PTH >500 pg/ml) in large portion of patients (n=833). Likewise in a significant part of our patients (44.9%) the parathormone level was low (PTH <150 pg/ml). The concurrent pathological elevation of both the serum calcium and the parathormone levels was found in only a minority of the patients (n=150; 2.8%). All of the drugs influencing calcium-phosphate and parathormone levels were already accessible during the time of origin of the trial in Hungary, although the financial limitations significantly affected their prescription. This is one of the reasons why local treatment practice was not fully aligned with guidelines. On the other hand the application of native vitamin D had an especially low prevalence. To sum up, our results match the European practice on the whole, although we definitely need improvement in reaching the treatment targets and also the clinical treatment practice leading to it. We will prepare a proposal for further analysis and longterm extension of this trial.]

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