Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study

被引:27
作者
Gallieni, Maurizio [1 ]
De Luca, Nicola [2 ]
Santoro, Domenico [3 ]
Meneghel, Gina [4 ]
Formica, Marco [5 ]
Grandaliano, Giuseppe [6 ]
Pizzarelli, Francesco [7 ]
Cossu, Maria [8 ]
Segoloni, Giuseppe [9 ]
Quintaliani, Giuseppe [10 ]
Di Giulio, Salvatore [11 ]
Pisani, Antonio [12 ]
Malaguti, Moreno [17 ]
Marseglia, Cosimo [13 ]
Oldrizzi, Lamberto [14 ]
Pacilio, Mario [2 ]
Conte, Giuseppe [2 ]
Dal Canton, Antonio [15 ,16 ]
Minutolo, Roberto [2 ]
机构
[1] Univ Milan, Nephrol & Dialysis Unit, Osped San Carlo Borromeo, Via Pio 2,3, I-20153 Milan, Italy
[2] Univ Naples 2, Naples, Italy
[3] Univ Messina, Messina, Italy
[4] Dolo Gen Hosp, Dolo Venice, Italy
[5] Osped Savigliano & Ceva, ASL Cuneo 1, Cuneo, Italy
[6] Univ Foggia, Dept Med & Surg Sci, Foggia, Italy
[7] SM Annunziata Hosp, Florence, Italy
[8] SS Annunziata Hosp, Sassari, Italy
[9] Univ Turin, Turin, Italy
[10] Osped S Maria Misericordia, Perugia, Italy
[11] S Camillo Forlanini Hosp, Rome, Italy
[12] Univ Naples Federico II, Naples, Italy
[13] C Poma Hosp, Mantua, Italy
[14] Osped Fracastoro, San Bonifacio, Italy
[15] Fdn IRCSS Policlin S Matteo, Pavia, Italy
[16] Univ Pavia, Via Palestro 3, I-27100 Pavia, Italy
[17] Osped San Paolo, Civitavecchia, Italy
关键词
Calcium; Phosphate; PTH; Vitamin D; Therapeutic inertia; Chronic kidney disease; Treatment; CHRONIC KIDNEY-DISEASE; PARATHYROID-HORMONE; MINERAL METABOLISM; VITAMIN-D; CARDIOVASCULAR-DISEASE; SERUM PHOSPHATE; MORTALITY; RISK; PREVALENCE; ASSOCIATION;
D O I
10.1007/s40620-015-0202-4
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Knowledge about mineral bone disorder (MBD) management in non-dialysis chronic kidney disease (ND-CKD) patients is scarce, although essential to identifying areas for therapeutic improvement. Methods We prospectively evaluated current management of CKD-MBD in two visits, performed 6 months apart, in 727 prevalent ND-CKD stage 3b-5 patients from 19 nephrology clinics. Therapeutic inertia was defined as lack of treatment despite hyperphosphatemia and/or hypocalcemia, and/or hyperparathyroidism. The primary endpoint was the prevalence of achieved target for CKD-MBD parameters and related treatments (phosphate binders, vitamin D and calcium supplements). The secondary endpoint was the assessment of prevalence and clinical correlates of therapeutic inertia. Results Over 65 % of patients did not reach parathormone (PTH) targets, while 15 and 19 % did not reach phosphate and calcium targets, respectively. The proportion of untreated patients decreased from stage 3b to 5 (at baseline, from 60 to 16 %, respectively). From baseline to the 6-month visit, the achievement of targets remained stable. Low protein diet was prescribed in 26 % of patients, phosphate binders in 17.3 % (calcium-based binders 15.5 %, aluminium binders 1.8 %), and vitamin D in 50.5 %. The overall prevalence of therapeutic inertia at the 6-month visit was 34.0 % (for hyperphosphatemia, 54.3 %). Compared to CKD stage 3, the likelihood of therapeutic inertia was 40 and 68 % lower at stage 4 and 5, respectively. Conclusions PTH, calcium and phosphate targets were not reached in a significant proportion of patients. One-third of patients with at least one MBD parameter not-at-target remained untreated. Therapeutic inertia regarding CKD-MBD treatment may be a major barrier to optimizing the prevention and cure of CKD-MBD.
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收藏
页码:71 / 78
页数:8
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