Abstract
Background and Aims
Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients.
Method
DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing.
Results
The % of patients with a high PTH (>600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices.
Conclusion
CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.
The Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor: Rationale and Methods for an Initiative to Monitor the New US Bundled Dialysis Payment System
