BACKGROUND: The impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease has not been assessed. METHODS: We compared albumin-adjusted serum calcium, phosphate, calcium x phosphate (Ca x P) product, and parathyroid hormone (PTH) values among active hemodialysis patients who received care at Dialysis Clinic Inc facilities during 8-month periods before (n = 9,516) and after (n = 9,543) the October 2003 release of the KDOQI guidelines. We examined the impact of missed sessions, abbreviated sessions, and patient-dietitian ratio on achievement of consistent control (defined as >or= 75% values within guideline targets) for each parameter. We also evaluated whether achievement of consistent control of a given parameter precluded control of another. RESULTS: There was a modest decrease in mean per-patient concentration for all mineral metabolic indicators after release of the guidelines. Similarly, the proportion of values within the recommended ranges for serum calcium, phosphate, and Ca x P product increased, but remained unchanged for PTH. The likelihood of achieving consistent control for each indicator increased when other parameters were concomitantly in range. Missed dialysis sessions were associated with a lower likelihood of achieving consistent control of calcium, phosphate, and Ca x P product levels, whereas abbreviated sessions were associated inversely with consistent achievement of phosphate and Ca x P product target levels. Variations in patient-dietitian ratio had no discernible association with mineral metabolic control. CONCLUSION: The KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease had a small, but noticeable, effect in the year after their release. Additional studies should evaluate whether achievement of the prescribed target levels confers an advantage with respect to relevant clinical outcomes.
BACKGROUND: The impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease has not been assessed. METHODS: We compared albumin-adjusted serum calcium, phosphate, calcium x phosphate (Ca x P) product, and parathyroid hormone (PTH) values among active hemodialysis patients who received care at Dialysis Clinic Inc facilities during 8-month periods before (n = 9,516) and after (n = 9,543) the October 2003 release of the KDOQI guidelines. We examined the impact of missed sessions, abbreviated sessions, and patient-dietitian ratio on achievement of consistent control (defined as >or= 75% values within guideline targets) for each parameter. We also evaluated whether achievement of consistent control of a given parameter precluded control of another. RESULTS: There was a modest decrease in mean per-patient concentration for all mineral metabolic indicators after release of the guidelines. Similarly, the proportion of values within the recommended ranges for serum calcium, phosphate, and Ca x P product increased, but remained unchanged for PTH. The likelihood of achieving consistent control for each indicator increased when other parameters were concomitantly in range. Missed dialysis sessions were associated with a lower likelihood of achieving consistent control of calcium, phosphate, and Ca x P product levels, whereas abbreviated sessions were associated inversely with consistent achievement of phosphate and Ca x P product target levels. Variations in patient-dietitian ratio had no discernible association with mineral metabolic control. CONCLUSION: The KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease had a small, but noticeable, effect in the year after their release. Additional studies should evaluate whether achievement of the prescribed target levels confers an advantage with respect to relevant clinical outcomes.
Authors: Jeffrey Perl; Laura M Dember; Joanne M Bargman; Teri Browne; David M Charytan; Jennifer E Flythe; LaTonya J Hickson; Adriana M Hung; Michel Jadoul; Timmy Chang Lee; Klemens B Meyer; Hamid Moradi; Tariq Shafi; Isaac Teitelbaum; Leslie P Wong; Christopher T Chan Journal: Clin J Am Soc Nephrol Date: 2017-03-17 Impact factor: 8.237
Authors: G Spasovski; V Zdravkovska; M Zabzun; R Antarorov; K Ivanovski; P Janakievska; J Neskovski; E Karceva-Sarajlia; B Panova; T Petrovska; L Zulbeari; J Masin-Spasovska; N Taleska-Matovska; S Gelev Journal: Int Urol Nephrol Date: 2011-12-16 Impact factor: 2.370
Authors: Rafael Weissheimer; Sergio Gardano Elias Bucharles; Cesar Augusto Madid Truyts; Vanda Jorgetti; Ana Elizabeth Figueiredo; Pasqual Barrett; Marcia Olandoski; Roberto Pecoits-Filho; Thyago Proença de Moraes Journal: J Bras Nefrol Date: 2021 Apr-Jun
Authors: Rachel M Holden; Sarah L Booth; Andrew G Day; Catherine M Clase; Deborah Zimmerman; Louise Moist; M Kyla Shea; Kristin M McCabe; Sophie A Jamal; Sheldon Tobe; Jordan Weinstein; Rao Madhumathi; Michael A Adams; Daren K Heyland Journal: Can J Kidney Health Dis Date: 2015-05-01