Maurizio Gallieni1, Nicola De Luca2, Domenico Santoro3, Gina Meneghel4, Marco Formica5, Giuseppe Grandaliano6, Francesco Pizzarelli7, Maria Cossu8, Giuseppe Segoloni9, Giuseppe Quintaliani10, Salvatore Di Giulio11, Antonio Pisani12, Moreno Malaguti13, Cosimo Marseglia14, Lamberto Oldrizzi15, Mario Pacilio2, Giuseppe Conte2, Antonio Dal Canton16, Roberto Minutolo2. 1. Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, University of Milano, via Pio II, 3, 20153, Milan, Italy. maurizio.gallieni@fastwebnet.it. 2. Second University of Naples, Naples, Italy. 3. University of Messina, Messina, Italy. 4. Dolo General Hospital, Dolo-Venice, Italy. 5. Ospedali di Savigliano e Ceva, ASL Cuneo 1, Cuneo, Italy. 6. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. 7. S.M. Annunziata Hospital, Florence, Italy. 8. SS Annunziata Hospital, Sassari, Italy. 9. University of Turin, Turin, Italy. 10. S. Maria della Misericordia Hospital, Perugia, Italy. 11. S. Camillo Forlanini Hospital, Rome, Italy. 12. University Federico II, Naples, Italy. 13. Ospedale San Paolo, Civitavecchia, Italy. 14. C. Poma Hospital, Mantova, Italy. 15. Ospedale Fracastoro, San Bonifacio, Italy. 16. Fondazione IRCSS Policlinico S. Matteo and University of Pavia, Pavia, Italy.
Abstract
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.
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.
Authors: Olivier Moranne; Marc Froissart; Jerome Rossert; Cedric Gauci; Jean-Jacques Boffa; Jean Philippe Haymann; Mona Ben M'rad; Christian Jacquot; Pascal Houillier; Benedicte Stengel; Bruno Fouqueray Journal: J Am Soc Nephrol Date: 2008-11-12 Impact factor: 10.121
Authors: Roberto Minutolo; Francesco Locatelli; Maurizio Gallieni; Renzo Bonofiglio; Giorgio Fuiano; Lamberto Oldrizzi; Giuseppe Conte; Luca De Nicola; Filippo Mangione; Pasquale Esposito; Antonio Dal Canton Journal: Nephrol Dial Transplant Date: 2013-10-21 Impact factor: 5.992
Authors: Alberto Martínez-Castelao; José L Górriz; José M Portolés; Fernando De Alvaro; Aleix Cases; José Luño; Juan F Navarro-González; Rafael Montes; Juan J De la Cruz-Troca; Aparna Natarajan; Daniel Batlle Journal: BMC Nephrol Date: 2011-10-05 Impact factor: 2.388
Authors: Antonio Bellasi; Luigi Morrone; Maria Cristina Mereu; Carlo Massimetti; Elena Pelizzaro; Giuseppe Cianciolo; Marzia Pasquali; Vincenzo Panuccio Journal: J Nephrol Date: 2018-03-07 Impact factor: 3.902