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Guideline–Practice Gap in the Management of Predialysis Chronic Kidney Disease Mineral Bone Disorder in Japan
Author(s) -
Hamano Takayuki,
Fujii Naohiko,
Matsui Isao,
Nakano Chikako,
Inoue Kazunori,
Tomida Kodo,
Mikami Satoshi,
Okada Noriyuki,
Tsubakihara Yoshiharu,
Rakugi Hiromi,
Isaka Yoshitaka
Publication year - 2011
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2011.00918.x
Subject(s) - medicine , guideline , kidney disease , intensive care medicine , bone mineral , pathology , osteoporosis
Abstract No study has reported the current status of the management of chronic kidney disease mineral bone disorder (CKD–MBD) in Japan. Using the Osaka Vitamin D Study in CKD (OVIDS–CKD), we examined the prevalence of patients with serum calcium, phosphate, parathyroid hormone (PTH), or 25‐hydroxyvitamin D levels outside the target of KDOQI guidelines. Eighty‐four percent of the patients had 25‐hydroxyvitamin D <30 ng/mL. Significant determinants of poor vitamin D status were female gender, diabetes, high PTH, and high urinary protein (2+ or greater). The percentage of patients with intact PTH higher than the target was 8% in CKD stage 3a, while between 20–22% in stages 3b to 5. The patients indicated for ergocalciferol were 7, 18, and 19% in stages 3a, 3b, and 4, respectively, and those indicated for active vitamin D were 21% in stage 5. Since neither ergocalciferol nor cholecalciferol is available in 2011 in Japan, we have no choice but to prescribe alfacalcidol or calcitriol; however, the percent of patients receiving these drugs was only 1, 4, 8, and 14% in stages 3a, 3b, 4, and 5, respectively, indicating that PTH and vitamin D status are not well controlled in Japan. In contrast, more than 80% of the patients met the target of serum calcium and phosphate. Contrary to expectations, nearly 20% of the patients had hypophosphatemia in stage 3 and 5, possibly because of strict protein restriction. Given these results, nephrologists should consider prescribing active vitamin D, especially for females and patients with diabetes, massive proteinuria, or secondary hyperparathyroidism.