Mineral bone disorder and its management among hemodialysis patients in the Gulf Cooperation Council: Initial findings from the dialysis outcomes and practice patterns study (2012-2015)

Abstract

The prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) initiated data collection in national samples of hemodialysis (HD) units (total of 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in late 2012. Here, we report initial results regarding mineral bone disorders (MBDs) and its management in the GCC countries. Forty-one randomly selected HD facilities, treating >23 HD patients each, were sampled and represent care for >95% of GCC HD patients. Descriptive results for the GCC countries based on a random sample of 20-30 HD patients in each study facility. Initial results for the GCC are from 931 HD patients treated at 41 dialysis units (ranging from 1 unit in Bahrain to 21 in Saudi Arabia). Results are presented as weighted estimates, accounting for the sampling fraction in each unit. Baseline descriptive statistics (e.g., mean, median, or percentage), weighted by facility sampling fraction were calculated for the study sample. For analyses examining the percent of facility patients having (a) serum phosphorus >6.0 mg/dL or (b) parathyroid hormone (PTH) >600 pg/mL, analyses were restricted to facilities having at least 10 HD patients with a reported serum phosphorus or PTH measurement, respectively. Logistic regression analyses of the indicated binary outcomes were based on the use of generalized estimating equations and were adjusted for GCC country, patient age category (<45 years, 45-65 years, and >65 years old), sex, and whether the patient was diagnosed with diabetes mellitus. Logistic models accounted for clustering of patients within facilities, assuming an exchangeable working correlation matrix. Mean age of HD patients in the GCC countries was 53 years vs. 61-64 years in the three other DOPPS regions. MBD markers showed slightly lower mean serum Calcium in the GCC countries, similar mean serum phosphorus, and intermediate median PTH levels compared with the three other DOPPS regions. Among GCC countries, the country mean value of MBD markers ranged from 8.6-9.0 mg/dL for serum calcium, 4.4-5.4 mg/dL for serum phosphorus, whereas median PTH ranged from 163-389 pg/mL. Similar to other DOPPS regions, PTH was higher among patients who were younger or without diabetes, and serum phosphorus was lower with older age (P <0.001 for each). History of parathyroidectomy was lower in the GCC countries versus other regions but did not differ when adjusted for age and dialysis vintage. Among treatments used for managing MBD, the GCC countries showed one of the highest uses of cinacalcet (24%) and phosphorus binder use (81%), whereas intravenous Vitamin D use (24%) was slightly higher than that in EURANZ. A much larger fraction of HD patients in the GCC countries had a dialysate calcium bath ≥3.5 mEq/L (43%) versus 0-4% in the three other DOPPS regions. Although many aspects of MBD management and MBD marker achievement are similar in the GCC countries to that seen in other DOPPS study regions, large variabi...

Phosphate binders usage, patients knowledge, and adherence

“…Patients below the upper limit )300 pg/ml( were 23.8% )n=67(; this upper limit was reported by 71% of the centers enrolled in the DOPPS involving GCC. 9 Our sample showed a high level of parathyroid hormone )64% [n=152]( consistent with the DOPPS study, which reported high median parathyroid level in Saudi Arabia )523 pg/ml( compared to the GCC average )452 pg/ml( this results are considered higher than results in Japan and Europe. Out of patients below upper limit, 4.8% )n=13( of patients showed levels of parathyroid hormone that considered as low bone turnover and required further assessment and treatment.…”

“…Thus, the control of serum phosphorus is considered a critical factor in improving the clinical outcomes in CKD-MBD, including survival. 8 , 9 Moreover, hyperphosphatemia represents a significant cause of morbidity and mortality in hemodialysis patients, as phosphate is not effectively removed by dialysis, the patients are required to follow a protein-restricted diet to decrease phosphate consumption. 10 Oral phosphate binders are required by the majority of patients on hemodialysis, which are agents used to control serum phosphate levels through different action mechanisms, but the net result is to prevent gastrointestinal phosphate absorption.…”

Pattern of Laboratory Parameters and Management of Secondary Hyperparathyroidism in Countries of Europe, Asia, the Middle East, and North America

“…The analysis described here includes data collected in the initial prevalent cross-section of patients enrolled in DOPPS phase 5 from 2012 to 2015 in 20,612 patients in 543 facilities across Europe (Belgium, France, Germany, Italy, Spain, Sweden, and the UK), Russia, Asia (China and Japan), Saudi Arabia (results for additional GCC countries have been published separately [23]), and North America (Canada and the USA). Specific parameters analyzed to assess the management of SHPT included biochemical measures and the use of SHPT medications.…”

“…More recently, using DOPPS phase 1–4 data (1996–2011), an iPTH elevation to > 600 pg/mL (HR 1.23) and even milder elevation of iPTH (301–450 pg/mL) were associated with mortality compared with the reference range of 150–300 pg/mL (HR 1.09) [ 22 ]. Initial findings from DOPPS phase 5 (2012–2015) in Russia and countries of the Middle East that are part of the Gulf Cooperation Council (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates) have demonstrated variation in practices and opportunities for improvement of care [ 23 , 24 ].…”

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

“…We were able to reveal patient characteristics on all study parameters. While existing studies in the region are limited to their descriptive and cross-sectional nature [28,29], or to their short intervention time [30], the current study is unique in its prospective interventional design implementing the IDE program in UAE.…”