Mineral and bone disorder in Chinese dialysis patients: a multicenter study

Abstract

BackgroundMineral and bone disorder (MBD) in patients with chronic kidney disease is associated with increased morbidity and mortality. Studies regarding the status of MBD treatment in developing countries, especially in Chinese dialysis patients are extremely limited.MethodsA cross-sectional study of 1711 haemodialysis (HD) patients and 363 peritoneal dialysis (PD) patients were enrolled. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH) were analyzed. The achievement of MBD targets was compared with the results from the Dialysis Outcomes and Practice Study (DOPPS) 3 and DOPPS 4. Factors associated with hyperphosphatemia were examined.ResultsTotal 2074 dialysis patients from 28 hospitals were involved in this study. Only 38.5%, 39.6% and 26.6% of them met the Kidney Disease Outcomes Quality Initiative (K/DOQI) defined targets for serum P, Ca and iPTH levels. Serum P and Ca levels were statistically higher (P < 0.05) in the HD patients compared with those of PD patients, which was (6.3 ± 2.1) mg/dL vs (5.7 ± 2.0) mg/dL and (9.3 ± 1.1) mg/dL vs (9.2 ± 1.1) mg/dL, respectively. Serum iPTH level were statistically higher in the PD patients compared with those of HD patients (P = 0.03). The percentage of patients reached the K/DOQI targets for P (37.6% vs 49.8% vs 54.5%, P < 0.01), Ca (38.6% vs 50.4% vs 56.0%, P < 0.01) and iPTH (26.5% vs 31.4% vs 32.1%, P < 0.01) were lower among HD patients, compared with the data from DOPPS 3 and DOPPS 4. The percentage of patients with serum phosphorus level above 5.5 mg/dL was 57.4% in HD patients and 47.4% in PD patients. Age, dialysis patterns and region of residency were independently associated with hyperphosphatemia.ConclusionsStatus of MBD is sub-optimal among Chinese patients receiving dialysis. The issue of hyperphosphatemia is prominent and needs further attention.

Alkaline Phosphatase and Mortality in Patients on Peritoneal Dialysis

“…Our study revealed that total serum ALP levels were associated with higher all-cause and cardiovascular mortality in PD patients, independent of serum calcium, phosphorus, iPTH, and liver enzymes (AST and ALT). It was reported that bone mineral disease characteristics are different in PD and HD (9) and that bone microarchitecture is more severely affected in patients on HD than patients receiving PD (8); however, our study indicated that the association between ALP and mortality in PD patients is similar with the previous study in HD patients (6).…”

“…Additionally, a cross-sectional study in China found that mineral and bone disorder (MBD) in PD patients is not as serious as in HD patients (9). However, whether a similar association between ALP and mortality also exists in PD patients is unknown.…”

Improving diet recipe and cooking methods attenuates hyperphosphatemia in patients undergoing peritoneal dialysis

“…Impaired renal phosphate clearance results in phosphate accumulation in the serum, which cannot be corrected by dialysis alone. Hence, >50% of patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) show elevated serum phosphate concentrations above the level recommended in the current guidelines [1,2]. Hyperphosphatemia is an independent predictor for cardiovascular and all-cause mortality in patients undergoing dialysis, because it contributes to vascular calcification, ventricular hypertrophy, additional mineral dysmetabolism, etc.…”

Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study

“…It is most prevalent among CKD patients receiving dialysis, with published estimates of prevalence ranging from 47 to 80 % [1][2][3][4]. A recent report from the COSMOS study found that most hemodialysis patients (70.5 %) had serum phosphorus levels that were above the normal range recommended by the kidney disease: improving global outcomes (KDIGO) guidelines (3.0-4.5 mg/dL) [4].…”