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Management of mineral metabolism in hemodialysis patients: discrepancy between interventions and perceived causes of failure

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Abstract

Background

Mineral and bone disorders (MBD) in patients undergoing hemodialysis (HD) are a major clinical complication. Current therapeutic strategies do not attain the expected results. The Italian audit on mineral metabolism was implemented to investigate MBD management through a “patient-oriented” approach.

Methods

Clinical and laboratory data pertinent to MBD from 509 prevalent adult patients on chronic HD were recorded and examined (audit), after which individual strategies were elaborated to improve MBD control. Their effectiveness was evaluated 6 months after the audit (Post-6).

Results

The audit disclosed poor MBD control in a high percentage of patients (56 %). Low compliance to treatment was the major determinant of failure (in 43.5 % of cases). Logistic regression showed a direct correlation between high degree of compliance and the achievement of therapeutic targets, e.g. parathyroid hormone: odds ratio (OR) 2.48, p = 0.015. In contrast, a minority of the proposed interventions (14.7 %) included strategies to improve patient compliance. At Post-6, despite a significant increase in drug prescription (p < 0.05 vs. audit), the rate of successful MBD control was unchanged.

Conclusions

Low compliance with treatment is a major, but still neglected, cause of failure in the achievement of MBD control in HD patients.

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Acknowledgments

We thank Elisabetta Azzoni and Alberto Rossi, part of ANM staff, for the help provided during all the phases of the study. We also thank Società Italiana di Nefrologia (SIN) for the scientific support. This study was supported by Accademia Nazionale di Medicina (ANM, Genova, Italy) that partially covered the travelling expenses for the auditors. The authors had no financial relationships with any organizations that might have an interest in the submitted work.

Conflict of interest

The authors state that this manuscript has not been published previously and is not currently being assessed for publication by any other journal. At the same time, on behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico “San Matteo” and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy

    Pasquale Esposito, Teresa Rampino, Marilena Gregorini & Antonio Dal Canton

  2. Unit of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy

    Carmine Tinelli & Annalisa De Silvestri

  3. Divisione di Nefrologia e Dialisi, Istituti Ospitalieri di Cremona, Cremona, Italy

    Fabio Malberti

  4. Nephrology, Dialysis and Transplantation Unit, City of Health and Science of Turin, Regina Margherita Children’s Hospital, Turin, Italy

    Rosanna Coppo

Authors
  1. Pasquale Esposito
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  2. Teresa Rampino
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  3. Marilena Gregorini
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  4. Carmine Tinelli
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  5. Annalisa De Silvestri
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  6. Fabio Malberti
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  7. Rosanna Coppo
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  8. Antonio Dal Canton
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IAMM Group

Corresponding author

Correspondence to Pasquale Esposito.

Additional information

The members of the IAMM Group are listed in the “Appendix”.

Appendix: members of the IAMM group

Appendix: members of the IAMM group

Alfredo Capuano, Diana Novizio (Divisione di Nefrologia Dialisi e Trapianto, Università Federico II, Napoli), Silvia Carozzi, Monica Repetto, Claudio Schelotto (Nefrologia, ASL 2 Presidio Ospedaliero San Paolo, Savona), Salvatore Carpentieri, Stefania Rossi (S.O.C. Nefrologia e Dialisi-ASL 9, Locri), Luigi Catizone, Alda Storari (U.O. Nefrologia Azienda Ospedaliera Universitaria Arcispedale Sant’Anna, Ferrara), Paolo Conti, Claudio Gabbrielli (S.C. di Nefrologia e Dialisi AUSL n 9 di Grosseto Osp. della Misericordia, Grosseto), Maria Cossu, Gianfranco Branca (S.C. di Nefrologia e Dialisi Trapianto-ASL Sassari), Ludovica Dapice, Caterina Saviano (Unità di Nefrologia e Dialisi, Ospedale Civile di Caserta), Goffredo Del Rosso, Patrizia Santarelli (U.O.C. Nefrologia e Dialisi P.O “G.Mazzini” ASL 106, Teramo), Marina Di Luca, Silvio Di Stante (U.O. Nefrologia e Dialisi A.O San Salvatore, Pesaro), Giorgio Feliciangeli, Giuseppe Cianciolo (U.O. di Nefrologia, Dialisi e Trapianto Policlinico S. Orsola-Malpighi, Bologna), Franca Giacchino, Franco Bonello (S.C. di Nefrologia e Dialisi-Ospedale Civile, Ivrea), Alessandro Leveque, Chiara Taglioni (Nefrologia e Dialisi, ASL 1, Ospedale Civile, Città di Castello), Marina Foramitti (U.O. Nefrologia e Dialisi-Istituti Ospitalieri di Cremona), Maria Cristina Mereu, Maria Chiara Cadoni (U.O. Nefrologia e Dialisi P.O. Ns Bonaria, San Gavino Monreale), Domenico Montanaro, Roberto Mioni (S.C. di Nefrologia e Dialisi-Az. Osp. Universitaria di Udine), Massimo Morosetti, Liljana Jankovic, Loredana Fortunato (U.O. Nefrologia e Dialisi Ospedale G.B. Grassi, Ostia), Lamberto Oldrizzi, Vincenzo Lidestri (U.O.C. Nefrologia e Dialisi ULSS 20, San Bonifacio), Giacomo Panarello, Domenico Schinella (S.C. Nefrologia e Dialisi, A.O. Santa Maria degli Angeli, Pordenone), Alessandra Perna (I Divisione di Nefrologia e Dialisi, Seconda Università degli Studi, Napoli), Giovanni Pertosa, Francesco Pesce (U.O. Emodialisi-Azienda Ospedaliera di Bari), Rodolfo Puccini, Raffaele Caprioli (Nefrologia Trapianti Dialisi -SSN 1, Azienda Ospedaliera Pisana, Pisa), Francesco Quarello, Marco Pozzato (S.C. di Nefrologia e Dialisi-Ospedale G. Bosco, Torino), Mario Salomone, Emanuele Stramignoni (Nefrologia e Dialisi-ASL TO 5, Chieri), Giovanna Sau, Pierina Amalia Menneas (S.S.D. Emodialisi Azienda Brotzu, Cagliari), Silvana Savoldi, Andrea Serra (S.C. di Nefrologia e Dialisi-ASL TO 4, Ciriè), Ugo Teatini, Giorgio Romei Longhena (U.O.C. Nefrologia e Dialisi Osp. di Bollate, Rho, Garbagnate, Az Osp. G. Salvini, Garbagnate Milanese), Giorgio Triolo, Alessandro Damiani (Nefrologia e Dialisi, CTO, Torino), Giuseppe Pontoriero (U.O. Nefrologia e Dialisi Ospedale Manzoni, Lecco), Ferdinando Avella, Paolo Frattolillo (Unità di Nefrologia e Dialisi, Ospedale Santa Maria della Pietà, Nola), Piergiorgio Bolasco, Andrea Galfrè (S.C. Territoriale di Nefrologia e Dialisi-ASL Cagliari, Quartu Sant’Elena, Cagliari), Maurizio Brigante, Giuseppe Di Cienzo (U.O.C. Nefrologia e Dialisi, Ospedale, Campobasso), Giuliano Brunori, Giuseppe Mondello (U.O. Nefrologia E Dialisi Ospedale Santa Chiara, Trento), Franco Cadinu, Patrizia Vatieri (U.O. Nefrologia e Dialisi-ASL Nuoro, Ospedale San Francesco, Nuoro), Leonardo Cagnoli, Fabio Badiali (U.O.C. Nefrologia e Dialisi AUSL Rimini), Giovanni Cancarini, Corrado Camerini (U.O. Nefrologia e Dialisi-Presidio Osp. A.O. Spedali Civili, Brescia).

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Esposito, P., Rampino, T., Gregorini, M. et al. Management of mineral metabolism in hemodialysis patients: discrepancy between interventions and perceived causes of failure. J Nephrol 27, 689–697 (2014). https://doi.org/10.1007/s40620-014-0100-1

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