Abstract: FR-PO276

International Serum 25-OH-Vitamin D Measurement, Levels, and Treatment among Patients with CKD in Everyday Nephrology Practice: Results from CKDopps

Session Information

Category: Mineral Disease

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

Authors

  • Liabeuf, Sophie, CHU Amiens, Amiens, France
  • Massy, Ziad, Ambroise Pare University Hospital, Boulogne Billancourt/ Paris cedex, France
  • McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Alabama, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Alabama, United States
  • Meier, Yvonne, Vifor Pharma Ltd, Glattbrugg, Switzerland
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Alabama, United States
  • Reichel, Helmut, Nephrological Center, Villingen-Schwenningen, Germany
  • Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, Paraná, Brazil
  • Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Alabama, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Alabama, United States
Background

CKD progression is linked to a decrease in 25 hydroxycholecalciferol (25[OH]D) with implications for secondary hyperparathyroidism. While the optimal target for 25[OH]D has been defined in the general population as 30 ng/ml, the optimal target in CKD patients (pts) is under debate. We evaluate current international vitamin D (vit D) practices among CKD pts.

Methods

CKD pts with eGFR <60 ml/min/1.73m2 (N=3,360) from nephrology clinics in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) (2013-2016) from Brazil (BR), Germany (GER) and the US were included. Serum 25[OH]D and prescribed vit D were each based on the first value reported in health records. Nephrologist preferences are from survey responses.

Results

25[OH]D level was reported for 54% of pts, but this varied across clinics by country, being measured for >90% of pts in 70% of GER clinics and 43-44% of US & BR clinics. Among pts with measured 25[OH]D, 46-66% had 25[OH]D<30 ng/mL across the countries and CKD stages. Figure 1 shows for the pts with 25[OH]D data: (a) vit D (nutritional and/or active) prescription was similar for pts with 25[OH]D D<30 vs >30 ng/ml; (b) fewer than half of pts prescribed vit D are prescribed active vit D. More pts had active vit D prescriptions in stages 4/5 (28%) vs stage 3 (12%).
Most US and BR nephrologists indicated a lower serum 25[OH]D target limit of 30 ng/mL. A few US, BR, and most GER nephrologists indicated 15-25 ng/mL. There was no consensus on the upper target limit. Neither limit differed by CKD stage.

Conclusion

Measurement of 25[OH]D levels is infrequent in many nephrology CKD clinics but common in others. Vit D prescription was similar for pts with 25[OH]D <30 v. >30. These findings raise questions regarding optimal approaches to incorporating serum 25[OH]D levels into broader MBD management in CKD practice.

Funding

  • Commercial Support