Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients

Paniagua, Ramón; Ventura, Marı́a-de-Jesús; Ávila-Díaz, Marcela; Hinojosa-Heredia, Héctor; Méndez-Durán, Antonio; Cisneros, Alejandra; Gómez, Ana María; Cueto-Manzano, Alfonso M.; Trinidad, Pedro; Obrador, Gregorio T.; García–López, Elvia; Lindholm, Bengt

doi:10.1016/j.arcmed.2013.01.008

Cited by 12 publications

(12 citation statements)

References 26 publications

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“…OPG was a better marker of AC than serum phosphorus and calcium, previously identified as important risk factor for vascular calcification [34,35], It was not a surprise since frequency of hyperphosphatemia (27% of patients had more than 5.5 mg/dL) in our population has been reported to be lower than in other countries [36]. This pattern is probably derived from low intake of phosphorus and an increased administration of calcium, both associated with current local practices, such as predominant use of PD, particularly with dialysate solutions with high calcium concentration, and calcium-based phosphate binders as the only available choice.…”

Section: Discussionmentioning

confidence: 95%

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

et al. 2017

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Background: Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). Methods: We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. Results: Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). Conclusion: OPG was the strongest risk factor associated with new development and rapidprogression of AC in incident PD patients.

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Section: Discussionmentioning

confidence: 95%

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

et al. 2017

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“…Adequate control of hyperphosphatemia is a cornerstone in the management of all CKD patients including those on peritoneal dialysis (PD). Due to the inherent limitations of phosphate removal across the peritoneal barrier, managing hyperphosphatemia in patients on PD is often a challenge although – according to KDOQI – target values for serum phosphate were reported to be reached as often in PD patients as in those treated by hemodialysis (6).…”

Section: Introductionmentioning

confidence: 99%

Phosphate Equilibration Rate and Daily Clearance in Patients on CAPD, CCPD and APD

Gómez¹,

Waniewski

Zapata³

et al. 2016

Int J Artif Organs

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“…Our study revealed 430 patients (57.6%) presented levels between 2.7 and 5.5 mg/dL, and 246 (32.9%) of the patients presented levels >5.6 mg/dL. Paniagua and colleagues [32] observed optimal levels of phosphorus, calcium, and PTH in 35, 32, and 12% of a sample with 753 patients. These results are similar to ours with the only limitation that PTH was underpowered to find any statistical significance.…”

Section: Discussionmentioning

confidence: 51%

Meeting Treatment Goals in Patients on Extramural Dialysis in Health Social Security in Mexico

et al. 2020

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Introduction: For the majority of renal replacement therapy history, the main treatment option for patients with end-stage renal disease (ESRD) in Mexico has been peritoneal dialysis. However, the use of hemodialysis is overwhelmingly increasing, driving public health care institutions to subrogate this service. Even when the actual hiring model for subrogation is accurate, there is a lack of quality control points in the hemodialysis prescription, poor adherence to clinical practice guidelines, and a few or no record of outcomes in hemodialysis patients of these subrogated services. The objective of this work is to fill this information gap to allow for uniform and safe hemodialysis for patients of Mexico. Material and Methods: An observational and cross-sectional study was performed, including all patients receiving chronic hemodialysis treatment in subrogated units of Mexican Social Security Institute (IMSS) in the northern region of Mexico City. Clinical and biochemical data as well as hemodialysis dose by Kt/V and urea reduction rate were collected and evaluated. To determine distribution, mean or median and SD or interquartile range were used; for nominal variables, the difference in proportions was estimated using the χ2 test; proportions were analyzed for biochemical values using the statistical package SPSS version 25. Results: In our study, >60% (485) of the patients were anemic with an average hemoglobin of 9.39 mg/dL (SD ± 1.83); serum calcium was found below 8.4 mg/dL in 51.3% (383) of patients, and only in 45.8% (342) was at an optimal level of this parameter. Only 33.5% of patients have arteriovenous fistula for dialysis access. The hemodialysis dose was optimal in >75% of patients. Conclusions: It is necessary to enhance and monitor treatment of comorbidities in patients with ESRD in subrogated hemodialysis units in México. We observed adequate prescription of hemodialysis in a majority of patients, achieving quality control points for removal of nitrogen products. Yet, there is a lack of quality control of comorbidities; therefore, we should aim to optimize treatment for mineral-bone disorder, anemia, and nutritional status.

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Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients

Cited by 12 publications

References 26 publications

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

Phosphate Equilibration Rate and Daily Clearance in Patients on CAPD, CCPD and APD

Meeting Treatment Goals in Patients on Extramural Dialysis in Health Social Security in Mexico

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