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Frequent monitoring of mineral metabolism in hemodialysis patients with secondary
hyperparathyroidism: associations with achievement of treatment goals and with
adjustments in therapy
#MMPMID26945054
Yokoyama K
; Kurita N
; Fukuma S
; Akizawa T
; Fukagawa M
; Onishi Y
; Kurokawa K
; Fukuhara S
Nephrol Dial Transplant
2017[Mar]; 32
(3
): 534-541
PMID26945054
show ga
BACKGROUND: Dialysis guidelines in Japan recommend more frequent measurement of
mineral metabolism markers than the Kidney Disease: Improving Global Outcomes
guidelines. However, the extent to which frequent marker measurement contributes
to achievement of target ranges and to therapy adjustment is unknown. METHODS:
This multicenter cohort study involved 3276 hemodialysis patients with secondary
hyperparathyroidism. Data on laboratory measurements and drug prescriptions were
collected every 3 months. Main exposures were frequencies of measuring serum
calcium and phosphorus [weekly/biweekly/monthly (reference)] and serum
parathyroid hormone (PTH) [monthly/bimonthly/trimonthly (reference)] levels.
Outcomes were achievement of guideline-specified ranges of mineral metabolism
markers when serum levels were over, and maintenance of ranges when levels were
already within, respective specified ranges, use of intravenous vitamin D
receptor activator (VDRA) and initiation of cinacalcet use. Associations were
examined via generalized estimating equations. RESULTS: When serum marker levels
exceeded the target range, weekly measurement of calcium and phosphorus was
positively associated with achievement of the guideline-specified calcium range
[adjusted odds ratio (AOR): 1.57, 95% confidence interval (CI) 1.09-2.26] but not
phosphorus range (AOR: 0.99, 95% CI 0.74-1.33). Monthly measurement of PTH was
positively associated with achievement of the guideline-specified PTH range (AOR:
1.14, 95% CI 1.01-1.27). When serum marker levels were within the
guideline-specified range, increased frequency of measurements was not associated
with in-range maintenance of marker levels for any of the three mineral markers
assessed. Regarding treatment regimen, relatively frequent measurement of serum
calcium and phosphorus was positively associated with cinacalcet initiation and
relatively frequent measurement of serum PTH with cinacalcet initiation and
intravenous VDRA use. CONCLUSIONS: Our results suggest that increasing frequency
of measurements is helpful when serum marker levels exceed the target range,
partially via adjustment in the therapeutic regimen. We found no evidence that
frequent measurements are helpful when mineral levels are already within target
ranges.
|Aged
[MESH]
|Biomarkers/blood
[MESH]
|Calcimimetic Agents/*therapeutic use
[MESH]
|Calcitriol/analogs & derivatives/therapeutic use
[MESH]
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