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  • Title: Impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in a large dialysis network.
    Author: Wald R, Tentori F, Tighiouart H, Zager PG, Miskulin DC.
    Journal: Am J Kidney Dis; 2007 Feb; 49(2):257-66. PubMed ID: 17261428.
    Abstract:
    BACKGROUND: The impact of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease has not been assessed. METHODS: We compared albumin-adjusted serum calcium, phosphate, calcium x phosphate (Ca x P) product, and parathyroid hormone (PTH) values among active hemodialysis patients who received care at Dialysis Clinic Inc facilities during 8-month periods before (n = 9,516) and after (n = 9,543) the October 2003 release of the KDOQI guidelines. We examined the impact of missed sessions, abbreviated sessions, and patient-dietitian ratio on achievement of consistent control (defined as >or= 75% values within guideline targets) for each parameter. We also evaluated whether achievement of consistent control of a given parameter precluded control of another. RESULTS: There was a modest decrease in mean per-patient concentration for all mineral metabolic indicators after release of the guidelines. Similarly, the proportion of values within the recommended ranges for serum calcium, phosphate, and Ca x P product increased, but remained unchanged for PTH. The likelihood of achieving consistent control for each indicator increased when other parameters were concomitantly in range. Missed dialysis sessions were associated with a lower likelihood of achieving consistent control of calcium, phosphate, and Ca x P product levels, whereas abbreviated sessions were associated inversely with consistent achievement of phosphate and Ca x P product target levels. Variations in patient-dietitian ratio had no discernible association with mineral metabolic control. CONCLUSION: The KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease had a small, but noticeable, effect in the year after their release. Additional studies should evaluate whether achievement of the prescribed target levels confers an advantage with respect to relevant clinical outcomes.
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