Achieving K/DOQI laboratory target values for bone and mineral metabolism: an uphill battle

Am J Nephrol. Jul-Aug 2004;24(4):422-6. doi: 10.1159/000080087. Epub 2004 Aug 11.

Abstract

Background: The National Kidney Foundation has recently published the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease (CKD). According to these guidelines, in patients with stage 5 CKD, the adjusted calcium level should be 8.4- 9.5 mg/dl, the serum phosphate should be 3.5-5.5 mg/dl, the calcium phosphorous product should be <55 mg(2)/dl(2) and the intact parathyroid hormone (PTH) level should be 150-300 pg/ml.

Methods: In order to evaluate our ability to meet these targets, we reviewed laboratory parameters of bone and mineral metabolism of 140 patients over a 6-month period in an inner city hemodialysis unit. Serum calcium and phosphate levels were determined using standard assays and PTH levels were determined using the Nichols Intact PTH assay.

Results: We found that the levels of serum calcium and serum phosphorus fell within the range recommended by the K/DOQI guidelines 49 and 36% of the time respectively. 57% of the determinations for calcium x phosphorus product were <55 mg(2)/dl(2). PTH levels were within the recommended values in 20% of the determinations. Only 7% of the determinations met all four criteria simultaneously in spite of meeting other K/DOQI targets such as hematocrit and dialysis adequacy.

Conclusion: These data indicate that current practice for the management of bone and mineral metabolism in hemodialysis falls far short of meeting the K/DOQI guidelines.

MeSH terms

  • Aged
  • Calcium / blood
  • Chronic Kidney Disease-Mineral and Bone Disorder / metabolism*
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / metabolism*
  • Kidney Failure, Chronic / metabolism*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Phosphorus / blood
  • Practice Guidelines as Topic
  • Renal Dialysis*
  • Treatment Outcome

Substances

  • Phosphorus
  • Calcium