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Titolo	Treating mineral metabolism disorders in patients undergoing long hemodialysis: A search for an optimal strategy
Autore	Guillaume JEAN, Thierry VANEL, Jean-Claude TERRAT, Jean-Marc HUROT, Christie LORRIAUX, Brice MAYOR, Charles CHAZOT - Centre de Rein Artificiel, 69160 Tassin la Demi-lune, France
Referenza	Hemodialysis International 2009; DOI:10.1111/j.1542-4758.2009.00394.x
Contenuto	In hemodialysis (HD) patients, mineral metabolism (MM) disorders have been associated with an increased mortality rate. We report the evolution of MM parameters in a stable HD population undergoing long hemodialysis by performing an annual cross-sectional analysis for every year from 1994 to 2008. The therapeutic strategy has changed: the dialysate calcium concentration has decreased froma mean of 1.7 0.1 to 1.5 0.07 mmol/L and has been adapted to parathyroid hormone serum levels (from 1 to 1.75 mmol/L). The use of calcium-based and aluminum-based phosphate binders has decreased and they have been replaced by sevelamer; alfacalcidol has partly been replaced by native vitamin D. The percentage of patients with a parathyroid hormone serum level between 150 and 300 pg/mL has increased from 9% to 67% (Po0.001); the percentage of patients with phosphataemia between 1.15 and 1.78 mmol/L has increased from 39% to 84% (Po0.001). The percentage of those with albumin-corrected calcemia between 2.1 and 2.37 mmol/L has increased from29% to 61% (Po0.001), and that of patients with a calcium-phosphorous product (Ca P) level 44.4 mmol/L decreased from 8.8% to 2% (P=0.02). Although patients undergo long and intensive HD treatment, MM disorders are common. However, an appropriate strategy, mostly consisting of native vitamin D supplementation, progressive replacement of calcium-based phosphate binders with non-calciumbased ones, and individualization of dialysis session duration and dialysate calcium concentration, would result in a drastic improvement.
Data	28.09.2009

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