MP566IMPLEMENTATION OF GUIDELINES ON MINERAL BONE DISEASE IN EUROPE, RESULTS FROM EURODOPPS

Abstract

Introduction and Aims: Abnormalities in serum calcium, phosphorus, parathyroid hormone and 25 hydroxyvitamin D concentrations are common in patients with chronic kidney disease and have all been associated with increased morbidity and mortality. In recent years many guidelines have been published to assist nephrologists in developing an integrated approach to the diagnosis and management of these disorders. To the best of our knowledge, data regarding guideline implementation by nephrologists in Europe are currently missing. Methods: Hemodialysis patients from EURODOPPS phase 4 (2009-2011) in the 7 European countries were selected and evaluated. Target ranges were based on Kidney Disease Improving Global Outcomes (KDIGO available for 2009-2011 period) and European guidelines (i.e. ERBP guidelines available for 2009-2011 period): serum calcium between 8.4 and 10.2 mg/dl, serum phosphate level between 3.5 and 5.5 mg/dl, serum PTH between 150 and 600 pg/ml, and serum 25 hydroxyvitamin D > 30 ng/ml. Results: A total of 6317 patients were included. Patients' characteristics were relatively similar across countries. Mean calcium levels were 8.97 mg/dl. Calcium levels were relatively high in the UK (with 9.5% being above and 78.2% on target), and low in Italy and Germany where 23.1 resp 23.4% were below target. Mean phosphate levels were 4.9 mg/dl, with 51.2% of the patients being on target (range between the countries 46.3-57.4). While patients in France tended to be more often below target (25.4%), in Germany many patients were above target (45.3%). Adjustment of the phosphate levels for the type and number of binders did not change the differences in mean levels of phosphate across countries. Median PTH levels were 197.5 pg/ml. 56.2% of the study population had a serum PTH levels between 150 and 600 pg/ml. 21.9% of patients with PTH more than 600 pg/ml had no treatment with vitamin D analogs or calcimimetics, when 29.1% of those on target did not received any of these treatments. Evaluation of serum 25 hydroxyvitamin D were only regularly collected in Belgium and France, and missing in nearly all Swedish, UK and Italian patients. Among those countries in which the information was available, the majority of patients had levels lower than the target (65.7%), but with strong variation across countries. In France, 49.6% had serum 25 hydroxyvitamin D levels less than 30 ng/ml, when this percentage was 76.5% in Germany. Conclusions: Guidelines implementation presented large differences between countries. These were only partly explained by differences in confounding factors and medication use(Figure Presented).