Effect of Bone Mineral Guideline Target Achievement on Mortality in Incident Dialysis Patients: An Analysis of the United Kingdom Renal Registry

Tangri, Navdeep; Wagner, Martin; Griffith, John L.; Miskulin, Dana C.; Hodsman, Alexandra; Ansell, David; Naimark, David

doi:10.1053/j.ajkd.2010.08.037

Cited by 47 publications

(64 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This was similar to a study conducted in the United Kingdom, in which the percentage of patients (with incident PD or HD) who achieved the KDOQI goals for serum calcium, phosphorus and i-PTH levels were 46.0%, 54.0% and 27.0%, respectively. (11) One-third of the study population reached the primary endpoint of all-cause mortality at the end of the third year of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…To investigate the importance of achieving the KDOQI targets on all-cause mortality at three years, Tangri et al conducted a study involving 4,947 incident HD patients and 2,129 incident PD patients from the United Kingdom Renal Registry. (11) In their adjusted proportional hazards model, patients who achieved the KDOQI targets in all quarters during the first year of dialysis were not found to have a survival advantage. Thus, the authors concluded that their findings did not support the use of KDOQI guidelines to achieve CKD-MBD targets.…”

Section: Introductionmentioning

confidence: 98%

“…Thus, the authors concluded that their findings did not support the use of KDOQI guidelines to achieve CKD-MBD targets. (11) In 2009, the Kidney Disease: Improving Global Outcomes (KDIGO) initiative published a guideline on the diagnosis, evaluation, prevention and treatment of CKD-MBD. (12) However,…”

Section: Introductionmentioning

confidence: 99%

“…(3,4,11) Furthermore, most of the studies did not include incident PD patients in their analyses. To the best of our knowledge, no studies to date have evaluated the clinical relevance of achieving the CKD-MBD targets in the 2009 KDIGO guidelines among PD patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Chuang

Wong

Vathsala

et al. 2016

smedj

View full text Add to dashboard Cite

INTRODUCTIONA complex relationship exists between chronic kidney disease-mineral and bone disorder (CKD-MBD) and adverse outcomes among dialysis patients. This study aimed to report the prevalence of CKD-MBD and examine the impact of achieving target CKD-MBD parameters on morbidity and mortality one year after peritoneal dialysis (PD) initiation. METHODSIn this retrospective cohort study, patients electively initiated on PD were followed up for one year. Laboratory parameters were collected and the prevalence of CKD-MBD 4-6 months after PD initiation was determined based on the Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Linear regression and Cox proportional hazards model were used to evaluate the effects of achieving CKD-MBD targets 4-6 months after PD initiation on hospitalisation, the incidence of peritonitis or exit-site infections (ESIs), and mortality at one year. RESULTSThe prevalence of CKD-MBD among the 86 patients in this study was 86.0% (KDOQI) and 54.7% (KDIGO).There was no significant difference in hospitalisation duration between patients who achieved targets and those who did not. Patients who failed to meet all the KDIGO CKD-MBD or calcium serum targets had a higher incidence of peritonitis or ESI. A trend toward shorter time to death was observed among patients who failed to meet the KDIGO phosphorus serum targets.CONCLUSION There was moderate (KDIGO) to high prevalence (KDOQI) of CKD-MBD among the patients. Achievement of all the KDIGO CKD-MBD or calcium serum targets was associated with reduced peritonitis or ESI, while achievement of the KDIGO phosphorus serum targets was associated with improved survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Chuang

Wong

Vathsala

et al. 2016

smedj

View full text Add to dashboard Cite

show abstract

“…Although several studies have examined the association between mineral levels and the impact of achievement of K/DOQI mineral target ranges on mortality rates in HD patients [3,4,5,6,8,9,10,11,12,13,14,15,19,31,32,] only a few studies have been conducted to date on incident HD patients [33,34]. Furthermore, evidence indicates that in incident HD patients, mortality rates are higher in the early stages (first 3-4 months) of dialysis, warranting studies in this setting [35].…”

Section: Introductionmentioning

confidence: 99%

Achievement of NKF/K-DOQI Recommended Target Values for Bone and Mineral Metabolism in Incident Hemodialysis Patients: Results of the FARO-2 Cohort

et al. 2014

View full text Add to dashboard Cite

Background: Mineral Bone Disorders (MBD) is prevalent in hemodialysis (HD) patients and associated with increased cardiovascular mortality. The FARO-2 study evaluated the achievement of the NKF/K-DOQI guidelines on recommended target values for serum calcium (Ca), phosphorous (P) and intact parathyroid hormone (PTH) levels on survival in incident HD patients. Methods: Data were collected by questionnaire from 568 incident HD patients followed prospectively over a 3-year period from 26 Italian dialysis units. The cumulative probability of time-to-death for CKD-MBD treatment characteristics was determined by the Kaplan-Meier curves. Results: Serum PTH levels (median values at 6 months vs. 36 months; 225 vs. 254 pg/ml), Ca (8.8 vs. 8.9 g/dl) and P (5.1 vs. 4.8 mg/dl) were not significantly different at 6 months versus follow-up. The majority of incident HD patients (60-70%) who were followed up for 36 months did not achieve the NKF/K-DOQI recommended target values. Survival rates were higher in patients on target for three parameters versus patients off target (survival at 24 months: at target 95.7% (95% CI: 84.0-98.9) versus not on target 71.1% (95% CI: 66.3-75.4, p < 0.01)). The 30.1% of patients on target for three MBD parameters at least once during the follow-up period had better survival rates compared to those not reaching these targets (survival at 24 months: at least once 88.0% (95% CI: 81.9-92.1); 67.7% (95% CI: 61.9-72.8, p < 0.01)). Conclusion: Our findings indicate that incident HD patients who achieved target levels (for three MBD parameters) for at least one visit have a lower risk of mortality.

show abstract

Achievements in CKD-MBD guidelines targets: is there a progress in the implementation practice?

Spasovski

Zdravkovska²,

Zabzun

et al. 2011

Int Urol Nephrol

View full text Add to dashboard Cite

There was an improved control of all bone and mineral parameters in our dialysis units, following the publication of the CKD-MBD KDOQI guidelines. In order to improve the iPTH values, a more frequent use of low Ca dialysate (1.25 mmol/L) and of non-calcium-based phosphate binders in this small subset of patients should be implemented, as recommended by the guidelines. Individualization of the CKD-MBD management may be successful, even when newer treatment options are not available. Finally, the guidelines implementation process should be a continuous and self-monitored process, with the help of periodic surveys.

show abstract

Effect of Bone Mineral Guideline Target Achievement on Mortality in Incident Dialysis Patients: An Analysis of the United Kingdom Renal Registry

Cited by 47 publications

References 12 publications

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Achievement of NKF/K-DOQI Recommended Target Values for Bone and Mineral Metabolism in Incident Hemodialysis Patients: Results of the FARO-2 Cohort

Achievements in CKD-MBD guidelines targets: is there a progress in the implementation practice?

Contact Info

Product

Resources

About