Dataset Information

A computerized treatment algorithm trial to optimize mineral metabolism in ESRD.

ABSTRACT:

Background and objectives

Achievement of mineral targets in patients receiving dialysis remains challenging. This study sought to evaluate outcomes for phosphorus, calcium, and parathyroid hormone when a dialysis population was switched from a predominantly active vitamin D analogue treatment regimen to a computerized algorithm incorporating both cinacalcet and active vitamin D as potential first-line therapies.

Design, setting, participants, & measurements

This longitudinal prospective trial enrolled 92 patients undergoing maintenance hemodialysis. Baseline measures (the average of the 3 months before computerized algorithm implementation) were compared with the proportion of patients achieving the prespecified targets at 6 and 12 months.

Results

After 6 months there was a statistically significant improvement in the percentage of patients achieving the primary and secondary phosphorus targets (primary: phosphorus ≤ 5.5 mg/dl, increase from 41% to 75%, P<0.001; secondary: phosphorus 3.0-4.6 mg/dl, increase from 16% to 38%; P=0.005). These improvements were sustained at 12 months. There was a statistically significant improvement in the percentage of patients achieving all three prespecified secondary endpoints (an increase from 12.8% to 25.6% at 12 months; P=0.04); however, this was mainly driven by improved phosphorus control. The proportion of patients achieving the primary or secondary parathyroid hormone targets did not improve.

Conclusions

A greater proportion of dialysis patients achieved improved phosphorus but not parathyroid hormone control by switching from a predominantly active vitamin D analogue-based treatment regimen for mineral and bone disorder to a computer-driven algorithm that incorporated cinacalcet and low-dose active vitamin D analogues as first-line therapy.

SUBMITTER: Spiegel DM

PROVIDER: S-EPMC3315337 | biostudies-literature | 2012 Apr

REPOSITORIES: biostudies-literature

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Publications

A computerized treatment algorithm trial to optimize mineral metabolism in ESRD.

Spiegel David M DM McPhatter Lesley L Allison Ann A Drumheller Joanne C JC Lockridge Robert R

Clinical journal of the American Society of Nephrology : CJASN 20120202 4

<h4>Background and objectives</h4>Achievement of mineral targets in patients receiving dialysis remains challenging. This study sought to evaluate outcomes for phosphorus, calcium, and parathyroid hormone when a dialysis population was switched from a predominantly active vitamin D analogue treatment regimen to a computerized algorithm incorporating both cinacalcet and active vitamin D as potential first-line therapies.<h4>Design, setting, participants, & measurements</h4>This longitudinal prosp ...[more]

PMID: 22300740

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Dataset Information

A computerized treatment algorithm trial to optimize mineral metabolism in ESRD.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

A computerized treatment algorithm trial to optimize mineral metabolism in ESRD.

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