Reappraisal of 2003 NKF-K/DOQI guidelines for management of hyperparathyroidism in chronic kidney disease patients

Monge, Matthieu; Shahapuni, Irina; Oprisiu, Roxana; Esper, N. El; Morinière, P; Massy, Ziad A.; Choukroun, Gabriel; Fournier, A

doi:10.1038/ncpneph0189

Cited by 19 publications

(15 citation statements)

References 60 publications

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“…As an explanation, we can hypothesize that the serum levels of hemoglobin, calcium, phosphorus, PTH and the Kt/V were relatively homogeneous in the study population as a consequence of the fact that all patients received erythropoietin to maintain hemoglobin levels between 11 and 12 g/l and were treated to target PTH levels and Kt/V according to the KDOQI guidelines [30] . Conversely, fatigue was positively correlated with serum albumin levels and negatively correlated with serum creatinine concentrations.…”

Section: Discussionmentioning

confidence: 99%

Fatigue and Its Correlates in Chronic Hemodialysis Patients

Bossola

Luciani

Tazza³

2009

Blood Purif

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Background: The present study aimed at evaluating the possible correlation between fatigue and demographic, clinical and laboratory variables in chronic HD patients. Methods: Sixty-two chronic HD patients were assessed for the presence of fatigue through the SF-36 Vitality subscale and were administered the Beck Depression Inventory (BDI), the Hamilton Anxiety Rating Scale (HARS), and the Mini-Mental State Examination. In all, the number/severity of comorbidities was assessed through the Charlson Comorbidity Index and laboratory parameters were measured. Results: Correlations among the SF-36 Vitality subscale and age, dialytic age, BDI, HARS and the Charlson Comorbidity Index were statistically significant. Correlations between the SF-36 vitality score and the serum creatinine, albumin and IL-6 levels were also significant. Twenty-six and 36 patients constituted the fatigued and nonfatigued groups, respectively. The age and the scores of the Charlson Comorbidity Index, BDI and HARS of fatigued patients were significantly higher than those of nonfatigued subjects. Serum IL-6 levels were significantly higher in the fatigued than in the nonfatigued group, whereas serum albumin and creatinine levels were significantly lower. Conclusions: We found that depression, anxiety, number and severity of comorbidities and IL-6 levels are significantly correlated with fatigue in end-stage renal disease patients receiving chronic hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Fatigue and Its Correlates in Chronic Hemodialysis Patients

Bossola

Luciani

Tazza³

2009

Blood Purif

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“…Recently, Jones [35] and Monge et al[ 36] have appealed for changes in the vitamin D KDOQI recommendations with the recognition of the dual role of vitamin D, direct VDR activity, and its ability to providing fuel for extrarenal α-hydroxylation. They have requested a change in guideline number 7 to ensure vitamin D sufficiency at all stages of CKD and the need for supplying active vitamin D when the blood PTH level rises.…”

Section: Discussionmentioning

confidence: 99%

Evidence for Persistent Vitamin D 1-Alpha-Hydroxylation in Hemodialysis Patients: Evolution of Serum 1,25-Dihydroxycholecalciferol after 6 Months of 25-Hydroxycholecalciferol Treatment

et al. 2008

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Background: End-stage renal disease (ESRD) patients are thought to have impaired 1-α-hydroxylase capacity, but an extrarenal source of 1,25(OH)₂D has been recognized. Objective: The aim of this study was to assess the evolution of serum 1,25(OH)₂D in hemodialysis (HD) patients with vitamin D deficiency after 6 months of 25(OH)D₃ supplementation, and to identify the factors associated with persistent 1,25(OH)₂D production. Methods: HD patients in a HD center with vitamin D deficiency (i.e. 25(OH)D <75 nmol/l) who were not receiving any vitamin D derivatives or calcimimetics were studied. Patients who had previously undergone parathyroidectomy or nephrectomy or those with uncontrolled hypercalcemia or hyperphosphatemia were excluded from this study. The patients were administrated a dose of 10–30 µg/day of oral 25(OH)D₃ based on the severity of their deficiency. The serum levels of 25(OH)D and 1,25(OH)₂D evolution after 6 months were recorded. Responders were defined as patients with an increase in serum 1,25(OH)₂D levels greater than the median value. Changes in mineral metabolism parameters were compared with those in the nonresponders. Results: Of the 253 patients, 225 (89%) were vitamin D-deficient, and 43 met the inclusion criteria. The patients were 72.6 ± 10 years old and had been on dialysis for 71 ± 70 months; 39% of the patients were female and 45% were diabetics. From baseline to 6 months of treatment, serum 25(OH)D levels increased from 27.8 ± 18 to 118 ± 34 nmol/l (p < 0.001) and serum 1,25(OH)₂D levels increased from 7.7 ± 5 to 30.5 ± 15 pmol/l (p < 0.001) with a median increase of 20 pmol/l. The mean serum calcium level increased from 2.19 ± 0.1 to 2.25 ± 0.1 mmol/l (p = 0.009), the intact parathyroid hormone (iPTH) level decreased from 144 ± 108 to 108 ± 63 pg/ml (p = 0.05), and the bone alkaline phosphatase (BALP) level remained unchanged. The serum phosphate level increased slightly from 1.22 ± 0.3 to 1.34 ± 0.2 mmol/l (p = 0.04) with reduced hypophosphatemia. Compared with the responders (n = 24), most of the nonresponders (n = 19) were diabetic (63 vs. 29%, p = 0.02) and had a lesser increase of their 25(OH)D serum level. The serum level of FGF-23 was not significant. A positive correlation was observed between serum 1,25(OH)₂D and serum 25(OH)D levels after 6 months of 25(OH)D₃ treatment (p = 0.02). Conclusion: The Kidney Disease Outcomes Quality Improvement (KDOQI) guidelines do not recommend checking and treating vitamin D deficiency in chronic kidney disease (CKD) stage 5 patients due to the supposed lack of 1,25(OH)₂D production. These data confirm persistent renal or extra-renal production of 1,25(OH)₂D in HD patients after 6 months of 25(OH)D₃ administration. Diabetes is the main factor associated with impaired 1,25(OH)₂D production. 25(OH)D₃administration corrects vitamin D deficiency with few effects on mineral metabolism a...

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“…Although such a high lower advisable limit of PTH is supposed to prevent the appearance of low remodeling bone disease, the evidence for such an advice is debatable. As commented by Monge et al [10], the NKF meta-analysis on bone histomorphometry established 60 pg/ml as the best threshold to predict adynamic bone disease [11]. Further, mortality has been demonstrated not to increase in the patients included in the USRDS reports having PTH <150 pg/ml [11].…”

Section: Methods In Producing Guidelinesmentioning

confidence: 97%

“…These points have also been challenged by the group of Fournier [10]. Fournier et al [16, 17] were the first in identifying the increase in secondary hyperparathyroidism when using low dialysate Ca.…”

Section: Methods In Producing Guidelinesmentioning

confidence: 97%

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Chronic Kidney Disease-Related Mineral and Bone Disorders

Argilés¹,

Vanholder

2009

Nephron Clin Pract

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The clinical practice guidelines, their scope, limitations and applicability within the field of mineral and bone disorders have been analyzed. The different available guidelines have been compared and their content has been put into the perspective of the user. The aim has been to review their accuracy and relevance for the key set of mineral and bone disorders, and not to attempt to rewrite them or provide new guidelines based on the authors’ feelings and experience.

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Reappraisal of 2003 NKF-K/DOQI guidelines for management of hyperparathyroidism in chronic kidney disease patients

Cited by 19 publications

References 60 publications

Fatigue and Its Correlates in Chronic Hemodialysis Patients

Fatigue and Its Correlates in Chronic Hemodialysis Patients

Evidence for Persistent Vitamin D 1-Alpha-Hydroxylation in Hemodialysis Patients: Evolution of Serum 1,25-Dihydroxycholecalciferol after 6 Months of 25-Hydroxycholecalciferol Treatment

Chronic Kidney Disease-Related Mineral and Bone Disorders

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