Controlling Bone Disease Improves Survival of Patients on Haemodialysis

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Title: Controlling Bone Disease Improves Survival of Patients on Haemodialysis
URL: http://www.pslgroup.com/dg/224D3E.htm
Doctor's Guide
July 2, 2008

Washington, DC -- July 2, 2008 -- Consistently maintaining certain blood levels of markers of bone metabolism and disease can prolong the lives of patients on haemodialysis, according to a study appearing in the September 2008 issue of the Clinical Journal of the American Society of Nephrology.

The findings indicate that keeping parathyroid hormone, calcium, and phosphorous levels in control is critically important for dialysis patients with chronic kidney disease (CKD).

Mark Danese, PhD, Outcomes Insights, Inc., Newbury Park, California, and colleagues set out to determine whether more consistent control of parathyroid, calcium, and phosphorous levels within the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) target ranges is associated with improved survival.

The study was conducted among 24,803 adults initiating dialysis between 2000 and 2002. The researchers assessed whether survival was improved when patients were within the 3 target levels simultaneously. They also examined whether survival was improved when patients were within each of the 3 target levels for prolonged periods of time.

The researchers reported that it was important to meet as many of the targets as possible at any given time. Meeting the target for none of the 3 markers was associated with a 51% higher risk of death compared with patients who achieved targets simultaneously for all 3 markers.

Patients meeting only 1 target had a 35% to 39% increased risk of death, and patients meeting any 2 targets had a 15% to 21% higher risk of death.

For each marker, patients who achieved target values for less than 3 months had the highest risk of death compared with those who did so for 1 year. Compared with patients whose individual target levels were maintained for 1 year, patients with a parathyroid in target for less than 3 months had a 34% higher risk of death, patients with calcium in target for less than 3 months had a 16% higher risk of death, and patients with phosphorous in target for less than 3 months had a 62% higher risk of death.

The study also revealed that prior to the introduction of the KDOQI guidelines, relatively few patients either simultaneously met the targets for parathyroid hormone, calcium, and phosphorous or met any target for a full year. The authors discovered that levels of these parameters outside the KDOQI target ranges may account for as much as 20% of deaths in dialysis patients.

"These results suggest that there is a need for more consistent achievement of the KDOQI mineral metabolism targets, and that meeting this need may result in improved survival for incident haemodialysis patients," the authors wrote. They note that this can be a challenge, however, because the use of current treatment options often requires a trade-off between controlling parathyroid hormone and controlling calcium and phosphorous.

SOURCE: The American Society of Nephrology

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