Analysis of serum phosphate control and phosphate binder utilization in incident hemodialysis patients

The purpose of this study was to conduct a retrospective analysis of serum phosphate level variability in patients new to hemodialysis (HD) and to identify patient characteristics associated with this variability. The medical records of 47,742 incident HD patients attending US outpatient dialysis ce...

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Published in:International journal of nephrology and renovascular disease 2014-01, Vol.7 (default), p.261-269
Main Authors: Farrand, Kimberly F, Copley, J Brian, Heise, Jamie, Fridman, Moshe, Keith, Michael S, Poole, Lynne
Format: Article
Language:English
Subjects:
Bone diseases
Care and treatment
Diabetes
Diagnosis
Diseases
Hemodialysis
Hemodialysis patients
Kidney diseases
Malnutrition
Measurement
Metabolism
Mortality
Original Research
Patients
Peritoneal dialysis
Phosphates
Phosphorus
Phosphorus imbalance
Physiological aspects
Prognosis
Risk factors
Serum
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container_title International journal of nephrology and renovascular disease
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creator Farrand, Kimberly F
Copley, J Brian
Heise, Jamie
Fridman, Moshe
Keith, Michael S
Poole, Lynne
description The purpose of this study was to conduct a retrospective analysis of serum phosphate level variability in patients new to hemodialysis (HD) and to identify patient characteristics associated with this variability. The medical records of 47,742 incident HD patients attending US outpatient dialysis centers between January 1, 2006 and March 31, 2009 were analyzed. Monthly mean serum phosphate levels determined over a 6-month evaluation period (months 4-9 after HD initiation) were assigned to one of three strata: low (5.5 mg/dL]). Patients were classified into one of six serum phosphate variability groups based on variability among monthly mean phosphate levels over the 6-month evaluation period: consistently target; consistently high; high-to-target; high-to-low; target-to-low; or consistently low. Only 15% of patients (consistently target group) maintained monthly mean serum phosphate levels within the target range throughout the 6-month evaluation period. Age, Charlson comorbidity index, serum phosphate, and intact parathyroid hormone levels prior to HD initiation were strongly associated (P
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The medical records of 47,742 incident HD patients attending US outpatient dialysis centers between January 1, 2006 and March 31, 2009 were analyzed. Monthly mean serum phosphate levels determined over a 6-month evaluation period (months 4-9 after HD initiation) were assigned to one of three strata: low (&lt;1.13 mmol/L [&lt;3.5 mg/dL]); target (1.13-1.78 mmol/L [3.5-5.5 mg/dL]); or high (&gt;1.78 mmol/L [&gt;5.5 mg/dL]). Patients were classified into one of six serum phosphate variability groups based on variability among monthly mean phosphate levels over the 6-month evaluation period: consistently target; consistently high; high-to-target; high-to-low; target-to-low; or consistently low. Only 15% of patients (consistently target group) maintained monthly mean serum phosphate levels within the target range throughout the 6-month evaluation period. Age, Charlson comorbidity index, serum phosphate, and intact parathyroid hormone levels prior to HD initiation were strongly associated (P&lt;0.001) with serum phosphate levels after HD initiation. Overall patient-reported phosphate binder usage increased from 35% at baseline to 52% at end of study. The low proportion of patients achieving target phosphate levels and low rates of phosphate binder usage observed during the study suggest that alternative strategies could be developed to control serum phosphate levels. Possible strategies that might be incorporated to help improve the management of hyperphosphatemia in incident HD patients include dietary modification, dialysis optimization, and earlier and sustained use of phosphate binders.</description><identifier>ISSN: 1178-7058</identifier><identifier>EISSN: 1178-7058</identifier><identifier>DOI: 10.2147/IJNRD.S58037</identifier><identifier>PMID: 25045277</identifier><language>eng</language><publisher>New Zealand: Dove Medical Press Limited</publisher><subject>Bone diseases ; Care and treatment ; Diabetes ; Diagnosis ; Diseases ; Hemodialysis ; Hemodialysis patients ; Kidney diseases ; Malnutrition ; Measurement ; Metabolism ; Mortality ; Original Research ; Patients ; Peritoneal dialysis ; Phosphates ; Phosphorus ; Phosphorus imbalance ; Physiological aspects ; Prognosis ; Risk factors ; Serum</subject><ispartof>International journal of nephrology and renovascular disease, 2014-01, Vol.7 (default), p.261-269</ispartof><rights>COPYRIGHT 2014 Dove Medical Press Limited</rights><rights>2014. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Farrand et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2229403473/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2229403473?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27923,27924,37011,37012,44589,53790,53792,74897</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25045277$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farrand, Kimberly F</creatorcontrib><creatorcontrib>Copley, J Brian</creatorcontrib><creatorcontrib>Heise, Jamie</creatorcontrib><creatorcontrib>Fridman, Moshe</creatorcontrib><creatorcontrib>Keith, Michael S</creatorcontrib><creatorcontrib>Poole, Lynne</creatorcontrib><title>Analysis of serum phosphate control and phosphate binder utilization in incident hemodialysis patients</title><title>International journal of nephrology and renovascular disease</title><addtitle>Int J Nephrol Renovasc Dis</addtitle><description>The purpose of this study was to conduct a retrospective analysis of serum phosphate level variability in patients new to hemodialysis (HD) and to identify patient characteristics associated with this variability. The medical records of 47,742 incident HD patients attending US outpatient dialysis centers between January 1, 2006 and March 31, 2009 were analyzed. Monthly mean serum phosphate levels determined over a 6-month evaluation period (months 4-9 after HD initiation) were assigned to one of three strata: low (&lt;1.13 mmol/L [&lt;3.5 mg/dL]); target (1.13-1.78 mmol/L [3.5-5.5 mg/dL]); or high (&gt;1.78 mmol/L [&gt;5.5 mg/dL]). Patients were classified into one of six serum phosphate variability groups based on variability among monthly mean phosphate levels over the 6-month evaluation period: consistently target; consistently high; high-to-target; high-to-low; target-to-low; or consistently low. Only 15% of patients (consistently target group) maintained monthly mean serum phosphate levels within the target range throughout the 6-month evaluation period. Age, Charlson comorbidity index, serum phosphate, and intact parathyroid hormone levels prior to HD initiation were strongly associated (P&lt;0.001) with serum phosphate levels after HD initiation. Overall patient-reported phosphate binder usage increased from 35% at baseline to 52% at end of study. The low proportion of patients achieving target phosphate levels and low rates of phosphate binder usage observed during the study suggest that alternative strategies could be developed to control serum phosphate levels. Possible strategies that might be incorporated to help improve the management of hyperphosphatemia in incident HD patients include dietary modification, dialysis optimization, and earlier and sustained use of phosphate binders.</description><subject>Bone diseases</subject><subject>Care and treatment</subject><subject>Diabetes</subject><subject>Diagnosis</subject><subject>Diseases</subject><subject>Hemodialysis</subject><subject>Hemodialysis patients</subject><subject>Kidney diseases</subject><subject>Malnutrition</subject><subject>Measurement</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Original Research</subject><subject>Patients</subject><subject>Peritoneal dialysis</subject><subject>Phosphates</subject><subject>Phosphorus</subject><subject>Phosphorus imbalance</subject><subject>Physiological aspects</subject><subject>Prognosis</subject><subject>Risk factors</subject><subject>Serum</subject><issn>1178-7058</issn><issn>1178-7058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptktuL1DAUh4so7rLum89SEMQHZ8y1aV6EYb2NLApenkOanEwztM1s0grrX2-6M64zYhJIOOc7v3AuRfEUoyXBTLxef_r89e3yG68RFQ-Kc4xFvRCI1w-P3mfFZUpblBeVVUXI4-KMcMQ4EeK8cKtBd7fJpzK4MkGc-nLXhrRr9QilCcMYQ1fqwR5ZGz9YiOU0-s7_0qMPQ-nnY7yFYSxb6IP1B9Fd9mdjelI8crpLcHm4L4of7999v_q4uP7yYX21ul4YTum4qClhQoCUlZG44iAtN4JUUDnBCbKcS4vB1VayWmonAJNKAuIiBxGEqaQXxXqva4Peql30vY63Kmiv7gwhbpSOozcdqLoBSyxxdVNphjSXzlJMGycY55XBKGu92WvtpqYHa3IeUXcnoqeewbdqE34qhiTjos4CLw8CMdxMkEbV-2Sg6_QAYUoKcyY4FVzyjD7_B92GKebWJEUIkQxRJuhfaqNzAn5wIf9rZlG1YghxIgmfqeV_qLwt9D63FJzP9pOAF0cBLehubFPoprm16RR8tQdNDClFcPfFwEjN86ju5lHt5zHjz44LeA__mT76Gy4y2Vo</recordid><startdate>20140101</startdate><enddate>20140101</enddate><creator>Farrand, Kimberly F</creator><creator>Copley, J Brian</creator><creator>Heise, Jamie</creator><creator>Fridman, Moshe</creator><creator>Keith, Michael S</creator><creator>Poole, Lynne</creator><general>Dove Medical Press Limited</general><general>Taylor &amp; 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The medical records of 47,742 incident HD patients attending US outpatient dialysis centers between January 1, 2006 and March 31, 2009 were analyzed. Monthly mean serum phosphate levels determined over a 6-month evaluation period (months 4-9 after HD initiation) were assigned to one of three strata: low (&lt;1.13 mmol/L [&lt;3.5 mg/dL]); target (1.13-1.78 mmol/L [3.5-5.5 mg/dL]); or high (&gt;1.78 mmol/L [&gt;5.5 mg/dL]). Patients were classified into one of six serum phosphate variability groups based on variability among monthly mean phosphate levels over the 6-month evaluation period: consistently target; consistently high; high-to-target; high-to-low; target-to-low; or consistently low. Only 15% of patients (consistently target group) maintained monthly mean serum phosphate levels within the target range throughout the 6-month evaluation period. Age, Charlson comorbidity index, serum phosphate, and intact parathyroid hormone levels prior to HD initiation were strongly associated (P&lt;0.001) with serum phosphate levels after HD initiation. Overall patient-reported phosphate binder usage increased from 35% at baseline to 52% at end of study. The low proportion of patients achieving target phosphate levels and low rates of phosphate binder usage observed during the study suggest that alternative strategies could be developed to control serum phosphate levels. Possible strategies that might be incorporated to help improve the management of hyperphosphatemia in incident HD patients include dietary modification, dialysis optimization, and earlier and sustained use of phosphate binders.</abstract><cop>New Zealand</cop><pub>Dove Medical Press Limited</pub><pmid>25045277</pmid><doi>10.2147/IJNRD.S58037</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Bone diseases
Care and treatment
Diabetes
Diagnosis
Diseases
Hemodialysis
Hemodialysis patients
Kidney diseases
Malnutrition
Measurement
Metabolism
Mortality
Original Research
Patients
Peritoneal dialysis
Phosphates
Phosphorus
Phosphorus imbalance
Physiological aspects
Prognosis
Risk factors
Serum
title Analysis of serum phosphate control and phosphate binder utilization in incident hemodialysis patients
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