Pasquale Esposito1, Teresa Rampino2, Marilena Gregorini2, Carmine Tinelli3, Annalisa De Silvestri3, Fabio Malberti4, Rosanna Coppo5, Antonio Dal Canton2. 1. Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy. pasqualeesposito@hotmail.com. 2. Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico "San Matteo" and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy. 3. Unit of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy. 4. Divisione di Nefrologia e Dialisi, Istituti Ospitalieri di Cremona, Cremona, Italy. 5. Nephrology, Dialysis and Transplantation Unit, City of Health and Science of Turin, Regina Margherita Children's Hospital, Turin, Italy.
Abstract
BACKGROUND: Mineral and bone disorders (MBD) in patients undergoing hemodialysis (HD) are a major clinical complication. Current therapeutic strategies do not attain the expected results. The Italian audit on mineral metabolism was implemented to investigate MBD management through a "patient-oriented" approach. METHODS: Clinical and laboratory data pertinent to MBD from 509 prevalent adult patients on chronic HD were recorded and examined (audit), after which individual strategies were elaborated to improve MBD control. Their effectiveness was evaluated 6 months after the audit (Post-6). RESULTS: The audit disclosed poor MBD control in a high percentage of patients (56 %). Low compliance to treatment was the major determinant of failure (in 43.5 % of cases). Logistic regression showed a direct correlation between high degree of compliance and the achievement of therapeutic targets, e.g. parathyroid hormone: odds ratio (OR) 2.48, p = 0.015. In contrast, a minority of the proposed interventions (14.7 %) included strategies to improve patient compliance. At Post-6, despite a significant increase in drug prescription (p < 0.05 vs. audit), the rate of successful MBD control was unchanged. CONCLUSIONS: Low compliance with treatment is a major, but still neglected, cause of failure in the achievement of MBD control in HD patients.
BACKGROUND: Mineral and bone disorders (MBD) in patients undergoing hemodialysis (HD) are a major clinical complication. Current therapeutic strategies do not attain the expected results. The Italian audit on mineral metabolism was implemented to investigate MBD management through a "patient-oriented" approach. METHODS: Clinical and laboratory data pertinent to MBD from 509 prevalent adult patients on chronic HD were recorded and examined (audit), after which individual strategies were elaborated to improve MBD control. Their effectiveness was evaluated 6 months after the audit (Post-6). RESULTS: The audit disclosed poor MBD control in a high percentage of patients (56 %). Low compliance to treatment was the major determinant of failure (in 43.5 % of cases). Logistic regression showed a direct correlation between high degree of compliance and the achievement of therapeutic targets, e.g. parathyroid hormone: odds ratio (OR) 2.48, p = 0.015. In contrast, a minority of the proposed interventions (14.7 %) included strategies to improve patient compliance. At Post-6, despite a significant increase in drug prescription (p < 0.05 vs. audit), the rate of successful MBD control was unchanged. CONCLUSIONS: Low compliance with treatment is a major, but still neglected, cause of failure in the achievement of MBD control in HDpatients.
Entities:
Keywords:
Clinical audit; Compliance; Hemodialysis; Mineral disorders; Quality improvement
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