Adherence to Mineral and Bone Disorder Clinical Practice Guidelines in Chronic Kidney Disease
Warisara Panawong BPharm*, Aporanee Chaiyakum BCP*, Cholatip Pongskul MD**
Affiliation : * Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand ** Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Mineral and bone disorders (MBD) in patients with chronic kidney disease (CKD) are cardiovascular risk
factors. Clinical practice guidelines were developed to prevent MBD and to decrease cardiovascular events in CKD patients.
Objective : To determine adherence to mineral and bone disorder clinical practice guidelines (MBD-CPG) in chronic kidney
disease patients.
Material and Method: A retrospective, observational study was performed on 206 patients with CKD stage 3, 4, and 5 that
were followed-up at pre-dialysis and dialysis clinic, Nephrology Unit, Srinagarind Hospital between July and September
2007.
Results : The mean percentages of adherence in each patient were 89.5% for calcium monitoring, 88.6% for phosphate
monitoring and 17.1% for PTH monitoring. The mean percentage of adherence to using of phosphate binder in each patient
was 84.6%. The mean percentage of adherence to using of vitamin D3 was 72.2% in patients who had all three clinical
parameters monitoring. The K/DOQI 2003 target recommendation achievements at the end of study were 73.7% for serum
calcium, 76.1% for serum phosphate, 94.6% for calculated CaxP product, and 23.7% for serum PTH. The mean percentage
of K/DOQI 2003 target recommendation achievement, in each patient during 12 months of postindex period, were: 79.3% for
serum calcium, 78.1% for serum phosphate, 95.8% for serum CaxP product and 26.3% for serum PTH. The 100%
achievement of target recommendations for serum calcium, serum phosphate and serum CaxP product were statistically,
significant different, when compared between the group of 100% and 75.0-99.9% adherence to using phosphate binder, with
the odd ratio 5.43 (95% CI 2.43-12.11) for serum calcium achievement, 11.33 (95% CI 4.63-27.72) for serum phosphate
achievement and 11.75 (95% CI 2.92-47.24) for CaxP product achievement.
Conclusion : The use of vitaminD3, monitoring of serum PTH and achieving of PTH target level, are still far from
recommendations. Therapeutic end point for cardiovascular and bone diseases should be investigated in long-term studies.
Keywords : Chronic kidney disease-mineral and bone disorder (CKD-MBD), Adherence, Mineral metabolism abnormality, Clinical practice guideline achievement
