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Titolo Impact of calcium, phosphate, PTH abnormalities and management on mortality in hemodialysis: Results from the RISCAVID study
Autore Vincenzo Panichi1, Roberto Bigazzi2, Sabrina Paoletti1, Emanuela Mantuano2, Sara Beati1, Valentina Marchetti3, Giada Bernabini1, Giovanni Grazi3, Riccardo Giusti4, Alberto Rosati4, Massimiliano Migliori1, Giancarlo Betti5, Antonio Pasquariello6, Erica Panicucci7, Giuliano Barsotti8, Antonio Bellasi9 - On behalf of the RISCAVID Study Group
Referenza Journal of Nephrology - In Press - published online: 26/03/2010
Contenuto Background: Despite substantial progress in medical care, the mortality rate remains unacceptably high in dialysis patients. Evidence suggests that bone mineral dismetabolism (CKD-MBD) might contribute to this burden of death. However, to date only a few papers have investigated the clinical relevance of serum mineral derangements and the impact of different therapeutic strategies on mortality in a homogeneous cohort of south European dialysis patients. Methods: The RISCAVID study was a prospective, observational study in which all patients receiving hemodialysis (HD) in the north-western region of Toscany in June 2004 were enrolled (N=757) and followed up for 24 months. Results: At study entry, only 71 (9%) patients of the entire study cohort exhibited an optimal control of serum phosphorous (Pi), calcium (Ca), calciumXphosphorous product (CAXPi) and intact parathyroidhormone (iPTH) according to the Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical guidelines. Despite a similar prevalence, the severity of CKD-MBD appeared different to the results reported in the USA. Interestingly, none of the serum biomarkers or number of serum biomarkers within KDOQI targets was independently associated with all-cause and cardiovascular (CV) mortality. Among treatments, Sevelamer was the only drug independently associated with lower all-cause and cardiovascular mortality (p<0.001). Conclusion: The RISCAVID study highlights the dif-ficulty of controlling bone mineral metabolism in HD patients and lends support to the hypothesis that a carefully chosen phosphate binder might impact survival in HD patients.
Data 27.05.2010
 
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