Optimal frequency of parathyroid hormone monitoring in chronic hemodialysis patients

Greenberg, Sheldon; Gadde, Swapnika; Pagala, Murali; Greenberg, Meidad; Shneyderman, Ilya; Janga, Kalyana

doi:10.5414/cn106657

Cited by 6 publications

(5 citation statements)

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“…Gaweda et al 15 examined the optimal frequency of hemoglobin sampling and concluded that weekly measurements associated with the lowest degree of hemoglobin variability. Greenberg et al 16 compared quarterly versus monthly monitoring policies for parathyroid hormone (PTH) and demonstrated that monthly measurement was associated with a higher likelihood of readings being within the recommended range. Yokoyama et al 17 concluded that in patients for whom serum CKD-MBD markers exceeded target range, weekly monitoring of calcium and monthly monitoring of PTH levels were associated with achievement of guidelinerecommended targets.…”

Section: Discussionmentioning

confidence: 99%

The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients

Thomas

Silver

Perl

et al. 2020

American Journal of Kidney Diseases

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Section: Discussionmentioning

confidence: 99%

The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients

Thomas

Silver

Perl

et al. 2020

American Journal of Kidney Diseases

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“…A change in monitoring frequency from quarterly to monthly can reportedly increase the percentage of patients reaching target iPTH values. 16 However, we often suggest iPTH monitoring every 3–6 months for maintenance hemodialysis patients in our own clinical practice. This protocol can be well received by patients because of its better cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the parathyroid function in maintenance hemodialysis patients from Changchun, China

Du¹,

Wang²,

Yu³

et al. 2017

Chronic Diseases and Translational Medicine

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ObjectiveTo evaluate the parathyroid function in maintenance hemodialysis patients from 4 hemodialysis centers and to analyze the cause of the dysfunction.MethodsThis cross-sectional study included patients with chronic renal disease undergoing maintenance hemodialysis treatment at 4 hemodialysis centers in Changchun, China, between March 2014 and August 2015. A total of 337 patients were asked to complete a questionnaire including their name, gender, age, hemodialysis duration, the use of calcium carbonate and vitamin D3 supplements, health education status, hemofiltration frequency, appetite, and education level. Serum intact parathyroid hormone (iPTH), phosphorus, total calcium, blood urea nitrogen (BUN), and creatinine (Cre) levels were obtained from clinical information. Patients with iPTH data were divided into 2 groups: Normal group: the patients with an iPTH level < 100 pg/ml (28 subjects); Abnormal group: the patients with an iPTH level > 100 pg/ml (136 subjects). Intergroup differences were analyzed using the t-test. The enumeration data were analyzed by the χ2 test.ResultsThe iPTH levels were not monitored for 173 maintenance hemodialysis patients (51.3%) but for 164 patients (48.7%). Of the 164 patients, 28 (17.1%) had a normal serum iPTH level, while the other 136 (82.9%) had an abnormal iPTH level. The maintenance hemodialysis duration and phosphorus levels in the Abnormal group were higher than those in the Normal group (P < 0.05). The appetites of patients in the Abnormal group were better than those of patients in the Normal group (P < 0.05).ConclusionsA lower proportion of patients on hemodialysis had a normal iPTH level. The phosphorus levels of patients on hemodialysis should be controlled via dietary interventions.

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“…Secondly, the unique measurement pattern for serum calcium/phosphorus levels (weekly/biweekly) observed in Japanese settings allowed us to analyze the effectiveness of intensive monitoring patterns on the likelihood of achieving target ranges or prescription change. In contrast, a previous before–after study in the USA was only able to examine the change in likelihood of achieving target ranges of PTH, calcium and phosphorus values after switching from trimonthly to monthly [ 10 ], which is less frequent than the ‘intensive monitoring (weekly/biweekly)’ pattern adopted in some Japanese facilities, likely because US facilities comply with the KDIGO guideline, whereas Japanese facilities comply with the JSDT guidelines (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Findings from a previous study suggested that the PTH target range specified in the KDOQI guidelines was achieved more often after frequency of monitoring mineral markers was switched from quarterly to monthly [ 10 ]. However, given that those results were obtained in a before–after study with no comparison group, conducted at a single center, whether the increased rate of achieving target range PTH levels was due to increased monitoring frequency or due to increased use of cinacalcet or vitamin D receptor activator (VDRA) irrespective of changes in monitoring frequency remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Frequent monitoring of mineral metabolism in hemodialysis patients with secondary hyperparathyroidism: associations with achievement of treatment goals and with adjustments in therapy

Yokoyama

Kurita

Fukuma

et al. 2016

Nephrol. Dial. Transplant.

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Background: Dialysis guidelines in Japan recommend more frequent measurement of mineral metabolism markers than the Kidney Disease: Improving Global Outcomes guidelines. However, the extent to which frequent marker measurement contributes to achievement of target ranges and to therapy adjustment is unknown. Methods: This multicenter cohort study involved 3276 hemodialysis patients with secondary hyperparathyroidism. Data on laboratory measurements and drug prescriptions were collected every 3 months. Main exposures were frequencies of measuring serum calcium and phosphorus [weekly/biweekly/monthly (reference)] and serum parathyroid hormone (PTH) [monthly/bimonthly/trimonthly (reference)] levels. Outcomes were achievement of guideline-specified ranges of mineral metabolism markers when serum levels were over, and maintenance of ranges when levels were already within, respective specified ranges, use of intravenous vitamin D receptor activator (VDRA) and initiation of cinacalcet use. Associations were examined via generalized estimating equations. Results: When serum marker levels exceeded the target range, weekly measurement of calcium and phosphorus was positively associated with achievement of the guideline-specified calcium range [adjusted odds ratio (AOR): 1.57, 95% confidence interval (CI) 1.09–2.26] but not phosphorus range (AOR: 0.99, 95% CI 0.74–1.33). Monthly measurement of PTH was positively associated with achievement of the guideline-specified PTH range (AOR: 1.14, 95% CI 1.01–1.27). When serum marker levels were within the guideline-specified range, increased frequency of measurements was not associated with in-range maintenance of marker levels for any of the three mineral markers assessed. Regarding treatment regimen, relatively frequent measurement of serum calcium and phosphorus was positively associated with cinacalcet initiation and relatively frequent measurement of serum PTH with cinacalcet initiation and intravenous VDRA use. Conclusions: Our results suggest that increasing frequency of measurements is helpful when serum marker levels exceed the target range, partially via adjustment in the therapeutic regimen. We found no evidence that frequent measurements are helpful when mineral levels are already within target ranges.

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Optimal frequency of parathyroid hormone monitoring in chronic hemodialysis patients

Cited by 6 publications

References 0 publications

The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients

The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients

Analysis of the parathyroid function in maintenance hemodialysis patients from Changchun, China

Frequent monitoring of mineral metabolism in hemodialysis patients with secondary hyperparathyroidism: associations with achievement of treatment goals and with adjustments in therapy

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