Can Calcium, Phosphate, Calcium Phosphate Product and Intact Parathyroid Hormone Levels Be Appropriately Controlled in Dialysis Patients?

• Published in: Medical principles and practice Vol. 20; no. 1; pp. 85 - 89
• Main Authors: Deger, S.M., Mutluay, R., Derici, U., Mandiralioglu, F., Arinsoy, T., Sindel, S.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 01.01.2011
• Subjects: Adult; Aged; Calcium - blood; Calcium Phosphates - blood; Female; Humans; Kidney Diseases - therapy; Male; Middle Aged; Original Paper; Parathyroid Hormone - blood; Peritoneal Dialysis; Phosphates - blood; Reference Values; Renal Dialysis; Retrospective Studies; Sickness Impact Profile; Turkey; Turkey; Dialysis; Vitamin D; Parathyroid hormone; Kidney Disease Outcome Quality Initiative; Phosphate; Mineral metabolism
• ISSN: 1011-7571; 1423-0151; 1423-0151
• DOI: 10.1159/000319768

Objective: To review the target levels of calcium (Ca), phosphate (P), calcium phosphate products (Ca × P) and intact parathyroid hormone (iPTH) levels in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) and compare them with the Kidney Disease Outcome Quality Initiative (K/DOQI) recommendations. Subjects and Methods: Three hundred and fifty-seven patients who had been undergoing dialysis for more than 3 months were included. Patients who had undergone a parathyroidectomy were excluded. The levels of Ca, P, iPTH and Ca × P were monitored for the last 3 months. The Ca and P levels were measured by standard techniques, and iPTH was assessed by the intact molecule assay. Results: Between HD and PD patients, there was no statistically significant difference for age, duration of dialysis or primary disease causing end-stage renal disease. The percentage of patients whose serum Ca, P, Ca × P product and iPTH were within K/DOQI recommended target ranges were 61.2, 66.4, 82.2 and 28.3% in HD patients, and 56.3, 60.6, 85.9 and 22.5% in PD patients, respectively. When all results for each group – HD and PD – were analyzed, 12.8% of patients had all 4 markers within the target range. Conclusion: Achieving target ranges of mineral markers is important in dialysis patients, but reaching K/DOQI target levels is difficult. Hence, physicians should be careful in using P binders and vitamin D analogs to achieve the normal ranges.