| 19464927 |
Byham-Gray L, Drasher T, Deckman K, Graham D, Liftman C, Roberto L, Peiffer P, Denmark R: Effect of aggressive osteodystrophy management on clinical outcomes in stage 5 chronic kidney disease. J Ren Nutr. 2009 Jul;19(4):321-33. Epub 2009 May 23.
OBJECTIVE: The study investigated whether the type of bone disease management (aggressive versus conventional) had an impact on clinical outcomes, namely bone health measures (e.g., biointact parathyroid hormone [BiPTH], serum corrected calcium [cCa] level, serum phosphorus [phos] level, and corrected calcium-phosphorus product [cCaPO (4)]). DESIGN AND SETTING: Retrospective chart review of 173 closed medical records of maintenance hemodialysis patients on thrice-weekly therapy from January 1, 2005, through December 31, 2005. Two Conventional Management (i.e., control group) and three Aggressive Management (i.e., treatment group) dialysis facilities were enrolled. RESULTS: There was a significant interaction for group assignment and BiPTH levels (F = 4.12, P = .01), with the Aggressive Group trending toward lower BiPTH levels than the Conventional Group. The Conventional Group experienced a significantly lower mean annualized serum cCa level (F = 8.85, P = .003), and used non-calcium-based binders significantly more (P < .0005) than the Aggressive Group. In terms of serum phos level, the Aggressive Group had a significantly lower (F = 2.73, P = .05) value than the Conventional Group. No significant differences were reported for cCaPO (4) product (F = 1.87, P = .17). The percentage of the total sample that achieved target range for all bone health measures included 29.8% (n = 50). CONCLUSIONS: The study demonstrated that aggressive bone disease management appears to be as effective as traditional interventions in the treatment of mineral and bone metabolism disorders in chronic kidney disease. |
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