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Are CSN and NKF-K/DOQI mineral metabolism guidelines for hemodialysis patients achievable? Results from a provincial renal program
By Lori D.Wazny, PharmD, Colette B. Raymond, PharmD, MSc, Esther M. Lesperance, RT, and Keevin N. Bernstein, MD, FRCPC
Abstract
Background: The calcium, phosphorus, and parathyroid hormone targets recommended by the Canadian Society of Nephrology (CSN) encompass a wider range of values as compared to the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines. We sought to compare min- eral metabolism parameters within the Manitoba Renal Program (MRP) to the CSN and NKF-K/DOQI guidelines. Medication use was also examined.
Methods: All hemodialysis patients in Manitoba were evaluated. Values for serum albumin, phosphorus, calcium, intact parathy- roid hormone (PTH) and pertinent medications were collected. Results: Five hundred and forty-six patients were included in the analysis. Fifty-three per cent to 81% of MRP patients met indi- vidual CSN targets. However, only 26% of patients achieved all targets, despite high usage of phosphate (85.5% calcium carbon- ate, 16.1% sevelamer, 1.3% aluminum) and PTH-lowering drug therapies (30.2% calcitriol, 2.7% cinacalcet).
Conclusion: Only a small proportion of patients were able to achieve all three CSN mineral metabolism targets simultaneously. The majority of outliers presented with hyperphosphatemia or hypoparathyroidism.
Key words: renal dialysis, calcium, phosphorus, hyperparathyroidism, secondary, practice guidelines
Author Affiliation(s):
Lori D. Wazny, PharmD, Clinical Pharmacist, Manitoba Renal Program.
Colette B. Raymond, PharmD, MSc, Clinical Pharmacist, Manitoba Renal Program.
Esther M. Lesperance, RT, Application Administrator, Manitoba Renal Program
Keevin N. Bernstein, MD, FRCPC, Professor, Faculty of Medicine, University of Manitoba