The DOPPS practice monitor for us dialysis care: Potential impact of recent guidelines and regulatory changes on management of mineral and bone disorder among us hemodialysis patients

摘要

During this time of clinical guideline and reimbursement policy changes, PTH levels have increased overall among US dialysis patients. Overall, this trend is consistent with findings from other DOPPS countries, with the exception of Japan.7 Because no trends in therapeutic regimens were observed that may explain the increase in PTH levels, it is likely that changes in MBD targets suggested in the 2009KDIGO chronic kidney diseaseMBD guideline 2 played a significant role. PTH levels were higher atdialysis units that reported higher PTH target levels. Whereas the increase in the upper limit of PTH target occurred sharply between 2010 and 2011, the shift toward higher targets for serum calcium level occurred more gradually. Given the recent increase in the percentage of patients with very high PTH levels, clinicians should continue to monitor MBD marker levels. Additional studies are needed to provide a higher level of evidence supporting a specific PTH target.