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Background
Guidelines should help the practicing nephrologists to reduce the variability in diagnostic and treatment strategies, and achieve the best possible patients’ outcomes. The aim of our study was to lookat the treatment strategies and the
shortcomings in the implementation of the chronic kidney disease mineraland bone disorder (CKD-MBD) KDOQI guidelines in dialysis units across the Republic of Macedonia in2009, and to analyze trends with regard to our previous analysis from 2005.Methods A questionnaire was sent in 2009 to all dialysis units in our country for data concerningCKD-MBD in dialysis patients. This study included 742 patients, comparable with the reply we got on thesame our 2005 survey, with a total of 588 patients. We collected the last 6 months mean values of biochemicalparameters [calcium (Ca), phosphate (P), and intact parathyroid hormone (iPTH)], as well astreatment data including dialysate Ca concentration, phosphate binding agents, and vitamin D doses.Results The majority of patients in both surveys hadvalues within the target ranges for all parameters,except for iPTH, which was \150 pg/ml in mostpatients, in both reports. Compared to the 2005 study, in 2009 we found a significantly improved control ofall four biochemical
parameters, but a greater proportionof patients within guidelines targets was foundonly for serum Ca (79 vs. 67.4%, P\0.05).
Treatment with low Ca dialysate concentration of1.25 mmol/L continued to be an underused option (3.7 vs. 6.1%), while the 1.75 mmol/L was still the standard dialysate in the majority of patients (57.7 vs. 64.2%). The dose of calcium carbonate was significantly reduced (2.77 ± 1.71 vs. 3.06 ± 1.54, P\0.01) in 2009 compared to 2005. The mean of the achieved targets increased significantly in 2009 (2.33 ± 1.05 vs. 2.13 ± 1.03, P\0.01).
Conclusion
There was an improved control of all bone and mineral parameters in our dialysis units, following the publication of the CKD-MBD KDOQI guidelines. In order to improve the iPTH values, a more frequent use of low Ca dialysate (1.25
mmol/L) and of non-calcium-based phosphate binders in this small subset of patients should be implemented, as recommended by the guidelines. Individualization of the CKD-MBD management may be successful, even when newer
treatment options are not available. Finally, the guidelines implementation process should be a continuous and self-monitored process, with the help of periodic surveys.
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