Age-dependent parathormone levels and different CKD-MBD treatment practices of dialysis patients in Hungary - results from a nationwide clinical audit

BMC Nephrology

Imre Kulcsár⁹  Sándor Túri³  Marietta Török¹  Ottó Árkossy⁶  Botond Csiky⁶  Erzsébet Ladányi⁶  József Balla²  János Szegedi⁸  András Szabó⁴  Csaba Ambrus⁵  Zoltán Kiss⁷  István Kiss⁵ 

[1] Diaverum Hungary Ltd., Budapest, Hungary;1st Department of Internal Medicine, Debrecen University Medical School, Debrecen, Hungary;Department of Pediatrics, Szent-Györgyi Albert University Medical School, Szeged, Hungary;2nd Department of Pediatrics, Semmelweis University Faculty of Medicine, Budapest, Hungary;Department of Nephrology-Hypertension, St Imre Teaching Hospital and B.Braun Avitum Hungary CPLC 1st Dialysis Centre, South-Buda Nephrology Centre, Halmi Street 20-22., Budapest H-1115, Hungary;Fresenius Medical Care Hungary Ltd., Budapest, Hungary;School for Ph.D. Candidates of Aesculap Academy, Budapest, Hungary;1st Department of Internal Medicine, Szabolcs-Szatmár-Bereg County Health Care Service Holding Corporation and 2nd Dialysis Centre of B. Braun Avitum Hungary CPLC, Nyíregyháza, Hungary;4th Department of Internal Medicine, Markusovszky Hospital of Vas County and 6th Dialysis Centre of B. Braun Avitum Hungary CPLC, Szombathely, Hungary

关键词: Phosphate (PO₄);    Parathyroid hormone (PTH);    End-stage renal disease (ESRD);    Chronic kidney disease (CKD);    Chronic kidney disease-mineral and bone disorder (CKD-MBD);    Calcium (Ca);   

Others  :  1082884
DOI  :  10.1186/1471-2369-14-155

 received in 2013-01-07, accepted in 2013-07-09,  发布年份 2013

【 摘 要 】

Background

Achieving target levels of laboratory parameters of bone and mineral metabolism in chronic kidney disease (CKD) patients is important but also difficult in those living with end-stage kidney disease. This study aimed to determine if there are age-related differences in chronic kidney disease-mineral and bone disorder (CKD-MBD) characteristics, including treatment practice in Hungarian dialysis patients.

Methods

Data were collected retrospectively from a large cohort of dialysis patients in Hungary. Patients on hemodialysis and peritoneal dialysis were also included. The enrolled patients were allocated into two groups based on their age (<65 years and ≥65 years). Characteristics of the age groups and differences in disease-related (epidemiology, laboratory, and treatment practice) parameters between the groups were analyzed.

Results

A total of 5008 patients were included in the analysis and the mean age was 63.4±14.2 years. A total of 47.2% of patients were women, 32.8% had diabetes, and 11.4% were on peritoneal dialysis. Diabetes (37.9% vs 27.3%), bone disease (42.9% vs 34.1%), and soft tissue calcification (56.3% vs 44.7%) were more prevalent in the older group than the younger group (p<0.001 for all). We found an inverse relationship between age and parathyroid hormone (PTH) levels (p<0.001). Serum PTH levels were lower in patients with diabetes compared with those without diabetes below 80 years (p<0.001). Diabetes and age were independently associated with serum PTH levels (interaction: diabetes × age groups, p=0.138). Older patients were more likely than younger patients to achieve laboratory target ranges for each parameter (Ca: 66.9% vs 62.1%, p<0.001; PO₄: 52.6% vs 49.2%, p<0.05; and PTH: 50.6% vs 46.6%, p<0.01), and for combined parameters (19.8% vs 15.8%, p<0.001). Older patients were less likely to receive related medication than younger patients (66.9% vs 79.7%, p<0.001).

Conclusions

The achievement of laboratory target ranges for bone and mineral metabolism and clinical practice in CKD depends on the age of the patients. A greater proportion of older patients met target criteria and received less medication compared with younger patients.

【 授权许可】

   
2013 Kiss et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Moe S, Drüeke T, Cunningham J, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G: Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int 2006, 69:1945-1953.
• [2]Rodriguez M, Nemeth E, Martin D: The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol 2005, 288:F253-F264.
• [3]Floege J, Kim J, Ireland E, Chazot C, Drueke T, de Francisco A, Kronenberg F, Marcelli D, Passlick-Deetjen J, Schernthaner G, Fouqueray B, Wheeler DC, ARO Investigators: Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant 2011, 26:1948-1955.
• [4]Kalantar-Zadeh K, Kuwae N, Regidor DL, Kovesdy CP, Kilpatrick RD, Shinaberger CS, McAllister CJ, Budoff MJ, Salusky IB, Kopple JD: Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int 2006, 70:771-780.
• [5]Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ, Strippoli GF: Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease. A systematic review and meta-analysis. JAMA 2011, 305(11):1119-1127.
• [6]Young EW, Akiba T, Albert J, McCarthy JT, Kerr PG, Mendelssohn DC, Jadoul M: Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2004, 44(5 Suppl 2):34-38.
• [7]Goodman WG, Goldin J, Kuizon B, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB: Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000, 342:1478-1483.
• [8]Bro S, Olgaard K: Effects excess PTH on nonclassical target organs. Am J Kidney Dis 1997, 30:606-620.
• [9]Szabó A, Mucsi I, Túri S, Kiss I, Poór G: Examination and treatment of renal osteodystrophy (ROD). Hypertonia és Nephrologia 2007, 11(5):217-232. in Hungarian
• [10]Olgard K: Clinical guide to bone and mineral metabolism in CKD. National Kidney Foundation; 2006.
• [11]K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease Am J Kidney Dis 2003, 42(4 Suppl 3):1-201.
• [12]KDIGO Clinical Practice Guideline for the Diagnosis: Evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 2009, 76(Suppl 113):1-130.
• [13]Szabó A, Deák G, Kiss I, Ladányi E, Mucsi I, Tislér A, Török M, Mátyus J, Reusz G, Haris Á, Nagy J, Szegedi J: Examination and treatment of CKD-MBD. Textbook of guidelines of Nephrology. Medition Publishing Ltd; 2011:1-25. in Hungarian
• [14]Kiss I, Kiss Z, Szabó A, Szegedi J, Balla J, Ladányi E, Csiky B, Árkossy O, Török M, Túri S, Kulcsár I: Guidelines and clinical practice: clinical audit of CKD-MBD in Hungarian dialyzed patients. Hypertonia és Nephrologia 2012, 16(1):23-30. in Hungarian
• [15]Berger JR, Hedayati S: Renal replacement therapy in the elderly population. Clin J Am Soc Nephrol 2012, 7:1039-1046.
• [16]Benner D, Nissenson AR, Van Wyck D: Focused clinical campaign improves mineral and bone disorder outcomes. J Ren Care 2011. [Epub ahead of print]
• [17]Toussaint ND, Pedagogos E, Beavis J, Becker GJ, Polkinghorne KR, Kerr PG: Improving CKD-MBD management in haemodialysis patients: barrier analysis for implementing better practice. Nephrol Dial Transplant 2011, 26:1319-1326.
• [18]Ward F, Watson A, Holian J: Chronic kidney disease-mineral and bone disorder (CKD-MBD) management and associated cost in an Irish haemodyalisis cohort. Nephrol Dial Transplant 2011, 26(10):3417.
• [19]Pelletier S, Roth H, Boucher JL, Drueke T, London G, Fouque D, the French Phosphorus and Calcium Observatory investigators: Mineral and bone disease pattern in elderly haemodialysis patients. Nephrol Dial Transplant 2010, 25:3062-3070.
• [20]Mucsi I, Hercz G: Adynamic bone disease: pathogenesis, diagnosis and clinical relevance. Curr Opin Nephrol Hypertens 1997, 6(4):356-361.
• [21]Pei Y, Hercz G, Greenwood C, Segre G, Manuel A, Saiphoo C, Fenton S, Sherrard D: Risk factors for renal osteodystrophy: a multivariant analysis. J Bone Miner Res 1995, 10(1):149-156.
• [22]Sugimoto T, Ritter C, Morrissey J, Hayes C, Slatopolsky E: Effects of high concentrations of glucose on PTH secretion in parathyroid cells. Kidney Int 1990, 37:1522-1527.
• [23]Pei Y, Hercz G, Greenwood C, Segre G, Manuel A, Saiphoo C, Fenton S, Sherrard D: Renal osteodystrophy in diabetic patients. Kidney Int 1993, 44(1):159-164.
• [24]Martinez I, Saracho R, Moina I, Montenegro J, Llach F: Is there a lesser hyperparathyroidism in diabetic patients with chronic renal failure? Nephrol Dial Transplant 1998, 13(suppl 3):9-11.
• [25]Fernández-Martín JL, Carrero JJ, Benedik M, Bos WJ, Covic A, Ferreira A, Floege J, Goldsmith D, Gorriz JL, Ketteler M, Kramar R, Locatelli F, London G, Martin PY, Memmos D, Nagy J, Naves-Díaz M, Pavlovic D, Rodríguez-García M, Rutkowski B, Teplan V, Tielemans C, Verbeelen D, Wüthrich RP, Martínez-Camblor P, Cabezas-Rodriguez I, Sánchez-Alvarez JE, Cannata-Andia JB: COSMOS: the dialysis scenario of CKD-MBD in Europe. Nephrol Dial Transplant 2012, 0:1-11.
• [26]Fukagawa M, Komaba H, Onishi Y, Fukuhara S, Akizawa T, Kurokawa K, MBD-5D Study Group: Mineral metabolism management in haemodialysis patients with secondary hyperparathyroidism in Japan: Baseline data from the MBD-5D. Am J Nephrol 2011, 33:427-437.
• [27]Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, Saito A, Rayner HC, Kurokawa K, Port FK, Held PJ, Young EW: Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the dialysis outcomes and practice patterns study (DOPPS) DOOPS. J Am Soc Nephrol 2003, 10:3270-3277.
• [28]Cannata-Andía JB, Fernández-Martín JL, Zoccali C, London GM, Locatelli F, Ketteler M, Ferreira A, Covic A, Floege J, Górriz JL, Rutkowski B, Memmos DE, Verbeelen D, Tielemans C, Teplan V, Bos WJ, Nagy J, Kramar R, Goldsmith DJ, Martin PY, Wüthrich RP, Pavlovic D, Benedik M: Current management of secondary hyperparathyroidism: multicenter observational study (COSMOS). J Nephrol 2008, 21:290-298.
• [29]Cannata-Andía JB, Carrera F: The pathophysiology of secondary hyperparathyroidism and the consequencies of uncontrolled mineral metabolism in chronic kidney disease: the role of COSMOS. Nephrol Dial Transplant Plus 2008, 1(Suppl 1):2-6.
• [30]Spasovski G, Zdravkovska V, Zabzun M, Antarorov R, Ivanovski K, Janakievska P, Neskovski J, Karceva-Sarajlia E, Panova B, Petrovska T, Zulbeari L, Masin-Spasovska J, Taleska-Matovska N, Gelev S: Achievements in CKD-MBD guidelines targets: is there a progress in the implementation practice? Int Urol Nephrol 2012, 44(6):1791-828.