Abstract: FR-PO294

Mineral and Bone Disorder (MBD) Markers and Management over the First 5 Years after Dialysis Start: Results from the DOPPS

Session Information

Category: Mineral Disease

  • 1202 Mineral Disease: Vitamin D, PTH, FGF-23

Authors

  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Meier, Yvonne, Vifor Pharma Ltd, St. Gallen, Switzerland
  • Jacobson, Stefan H., Danderyd Hospital, Stockholm, Sweden
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, KANAGAWA, Japan
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Abnormalities in MBD markers - including parathyroid hormone (PTH), serum phosphorus (P), calcium, and 25-hydroxy (OH) vitamin D - in the period immediately following hemodialysis (HD) initiation may increase short- and long-term risk of morbidity and mortality. International and racial variations in MBD markers and treatments have been well-described, but not their trajectories after transition to HD.

Methods

Locally weighted regression (LOESS) was used to smooth trends in mean MBD markers and drug prevalence over the first 5 years of HD using 472,930 patient-months from 34,105 patients in phases 4-5 (2009-2015) of the Dialysis Outcomes and Practice Patterns Study (DOPPS).

Results

PTH levels were high at HD initiation, especially among black patients in the US. PTH then declined during the first year of HD before increasing in the US and Europe but not in Japan. P levels increased sharply after HD initiation before subsequently declining in Europe but not in the US or Japan. Active vitamin D and cinacalcet prescription increased over 5 years, and was greatest in US black patients. Oral nutritional vitamin D was not prescribed in Japan, but was in Europe (27%) and the US (12%) despite infrequent measurement of 25-OH vitamin D.

Conclusion

Variation in PTH at HD initiation by region and race may reflect differences in patient characteristics, pre-HD care, and/or timing of HD initiation. After an initial decline, we observed a rise in PTH with time on HD in US patients, particularly black patients, despite greater prescription of vitamin D and cinacalcet than in other regions. The rapid rise in P immediately following HD initiation may be partially attributable to loss of residual renal function. Future research is needed to study how MBD management before, during, and after the transition to HD can be optimized to improve clinical outcomes.

Funding

  • Commercial Support