Mineral metabolism has emerged as an important predictor of morbidity and mortality in maintenance hemodialysis (MHD) and in peritoneal dialysis (PD) patients. However, the attainment of the K/DOQI target values for serum calcium, phosphate and iPTH is quite difficult.
Aim: To assess the prevalence of the different patterns of renal osteodystrophy and the percentage of MHD and PD patients who met the K/DOQI targets for bone and mineral metabolism, according to the different dialytic and pharmacological treatments.
A total of 105 MHD and 18 PD patients were examinated. Table 1 shows their clinical data. Ten MHD and 1 PD patient had been para-thyroidectomized. Serum urea, creatinine, calcium, phosphate, iPTH, alkaline phosphatase (ALP) were determined with standard laboratory methods. Dialytic efficiency was measured as spKt/V for MHD and weekly Kt/Vurea for PD patients. MHD patients were treated with a standard schedule of 3 sessions/week (mean lenght 3.8±0.3 hours). Standard hemodialysis (HD) in 77, hemodiafiltration (HDF) in 28 pts. CAPD in only 2 patients, APD in the remaining 16 patients.
Table 2 shows the laboratory results. Twenty-five MHD patients received no pharmacological treatment, while all PD patients received at least one drug. Either MHD and PD patients were treated more frequently with calcium-based phosphate blockers, VitD/analogues and, finally, cinacalcet. Table 3 describe the achievement of K-DOQI target values in MHD e PD patients. On the basis of s-iPTH and ALP, there were no differences of bone turnover between MHD and PD patients. PD patients had a better phosphate control, also considering their residual renal function while a worse control of serum calcium.
Low bone turnover (LBT) is present in one third of our dialytic patients (MHD and PD), suggesting possible over-treatment, while the analysis of the drug regimen of patients with high bone turnover (HBT)demonstrates a possible under-treatment.
