Impact of Accessibility to Non-Calcium-Based Phosphate Binders and Calcimimetics on Mineral Outcomes in Maintenance Hemodialysis
- Bone and Mineral Metabolism: CKD-MBD Updates
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
- Disthabanchong, Sinee, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Krung Thep (Bangkok), Thailand
Traditional management of CKD-MBD with calcium and active vitamin D results in hypercalcemia and calcification. Newer drugs including non-calcium-based phosphate binders (NCBPBs) and calcimimetics may help achieving the treatment targets with less hypercalcemia and calcification. In our country, NCBPBs and calcimimetics are not covered in social security and universal coverage reimbursement schemes (SS/UC), whereas they are covered in civil servant and state enterprise reimbursement schemes (CS/SE). Our institution serves both groups of patients providing a unique opportunity to study the differences in mineral outcomes.
This is a retrospective cohort study that included maintenance hemodialysis (MHD) patients between 2015–2022. Patients were categorized into two groups according to their reimbursement schemes (SS/UC or CS/SE). Differences in mineral parameters were compared using linear mixed models. The composite endpoint of parathyroidectomy and severe hyperparathyroidism (HPT) (PTH ≥1500 pg/mL) was analyzed by multivariate Cox-Proportional Hazard regression.
A total of 714 patients were included. The average serum calcium and phosphate and proportions of patients with hypercalcemia and hyperphosphatemia were substantially higher in SS/UC group compared with CS/SE group. Parathyroid hormone levels were comparable but the proportion of patients with HPT was significantly higher in SS/UC group. The composite endpoint of parathyroidectomy and severe HPT was also significantly higher in SS/UC group. A sensitivity analysis in 563 patients who were prescribed at least 1 type of CKD-MBD medications yielded similar findings.
MHD patients who did not have access to NCBPBs and calcimimetics showed poorer mineral outcomes compared with those who had access to the drugs.