Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients
| Autor: | María-de-Jesús Ventura, Gregorio T. Obrador, Marcela Ávila-Díaz, Ramón Paniagua, Ana María Gómez, Pedro Trinidad, Antonio Méndez-Durán, Alfonso M. Cueto-Manzano, Héctor Hinojosa-Heredia, Alejandra Cisneros, Bengt Lindholm, Elvia García-López |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Calcium Carbonate Peritoneal dialysis Phosphorus metabolism Cohort Studies Renal Dialysis Risk Factors Internal medicine Diabetes Mellitus medicine Humans Risk factor Intensive care medicine Mexico Survival rate business.industry Continuous ambulatory peritoneal dialysis Phosphorus General Medicine Guideline Middle Aged Survival Rate Treatment Outcome Parathyroid Hormone Practice Guidelines as Topic Kidney Failure Chronic Calcium Female Hemodialysis business Peritoneal Dialysis Cohort study |
| Zdroj: | Archives of Medical Research. 44:229-234 |
| ISSN: | 0188-4409 |
| DOI: | 10.1016/j.arcmed.2013.01.008 |
| Popis: | Background and Aims An increasing number of studies have been published concerning meeting targets of clinical guidelines for different aspects of the diagnosis and treatment of patients with end-stage renal disease. Most of these studies have shown that guideline recommendations are not always satisfied, and results outside target limits have been associated with high rates of mortality and morbidity. The objective of this study was to analyze the frequency of reaching mineral and bone metabolism-related guideline targets and its impact on clinical outcomes in Mexican chronic dialysis patients. Methods A cohort of prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients were analyzed at baseline and followed for at least 16 months. Patients were on continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and HD and contracted HD modalities where patients received HD sessions outside institution facilities. Results We studied 753 patients. The percentage of patients within target limits for phosphorus was 35%, for calcium 32%, and for PTH 12%. The most frequent pattern was hyperphosphatamia, hypercalcemia, and low PTH. This was even more frequent in CAPD patients, probably due to the high percentage of diabetic patients. Hypercalcemia was found as an independent risk factor for mortality. Conclusions The most important results suggest that guideline recommendations are not usually satisfied and that hypercalcemia, in addition to other traditional risk factors, is associated with high mortality rates. The study also detected some opportunities to improve the quality of treatment by reducing the calcium content of dialysis solutions and reducing the use of calcium carbonate as a phosphate binder. |
| Databáze: | OpenAIRE |
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