BMD in peritoneal dialysis: what BRAZPD can help us understand?

Abstract

BMD in peritoneal dialysis: what BRAZPD can help us understand?DMO na diálise peritoneal: o que o BRAZPD nos ajuda a compreenderThe Brazilian Study of Peritoneal Dialysis II (BRAZPD II) was a milestone in clinical research, as it was the first large cohort in Latin America to show characteristics of patients on peritoneal dialysis (PD), clinical practices, techniques and their correlations with clinical results. One hundred and twenty-two clinics from different parts of the country participated in the study, with 9,905 patients, from December 2004 to January 2011.The data collected from this cohort gave rise to other studies, resulting in 33 published papers and 627 citations, which shows the impact and importance of the BRAZPD in the nephrological community.Studies on mineral and bone metabolism disorder (BMD) in PD, most of which were carried out with a small number of patients, date from 1982. These studies were largely associated and addressed the pathophysiology of renal osteodystrophy (RO), the concentration of calcium (Ca) in the dialysate and the use of Ca-based phosphorus chelators, among others. In the past, the possibilities of controlling biochemical changes in PD were limited, boiling down to the use of calcium carbonate (CaCO3) to control hyperphosphatemia and to manage the Ca concentration in the dialysis bath to treat hypercalcemia. Subsequently, in the 1990s, calcitriol and sevelamer were added for the treatment of secondary hyperparathyroidism (HPTS) and, in 2016, cinacalcet and paricalcitol.Recently, the BJN published two more studies from the BRAZPD:1. "High prevalence of biochemical disturbances of chronic kidney disease mineral and bone disorders