Mineral and bone status in French maintenance hemodialysis patients: A comparison of June 2005 and June 2008

Introduction. - Because of the high associated morbi-mortatity, phosphate and calcium disorders remain a major therapeutic challenge for nephrologists. Previous studies showed that only few patients had serum calcium, phosphate and parathyroid hormone within Kidney-Disease Outcomes Quality Initiative (K/DOQI) targets. Patients and methods. - The French calcium and phosphate observatory monitors mineral metabolism at local, regional and national level and its follow-up every six months since 2005. More than 200 nephrologists collected more than 9000 patients' data. We compared the results recorded in June 2005 with those collected in June 2008. Results. - As compared with June 2005, in June 2008 fewer patients were hypercalcemic according to the K/DOQI targets (-26.2%, p < 0.001) and hyperphosphatemic (-16.5%, p < 0.001), more patients were hypocalcemic (+45.5%, p < 0.001) and hypophosphatemic (+8.8%, p < 0.02). A greater number of patients had elevated serum PTH above 300 ng/l (+17.6%, p < 0.001) and fewer had a PTH lower than 150 ng/l (-25.4%, p < 0.001). Serum 25OH vitamine D level was 21.7 +/- 20.0 mu g/l in June 2008. Overall, 10.5% of patients met all three K/DOQI targets, an improvement compared with June 2005 (6.8%, p < 0.001). Between 2005 and 2008, cinacalcet, Lanthane carbonate and native vitamine D derivatives prescription increased whereas calcium-based phophate binders, sevelamer-HCL and active vitamine D derivatives decreased. Conclusion. - Despite a significant improvement between 2005 and 2008, only few patients reach the three K/DOQI targets (10.5%) in 2008. The prospective biannual follow-up during three years wilt allow us to identify the impact of different treatments on calcium and phosphate metabolic control and patient's survival. C() 2009 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.