Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

Kyubok Jin, Tae Hyun Ban, Ji Yong Jung, Ae Jin Kim, Yaerim Kim, So Young Lee, Dong Ho Yang, Bum Soon Choi, Kook Hwan Oh, Jieun Kim, Young-Joo Kwon, Jong Wook Choi, Gheun Ho Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD. Methods: A total of 355 patients on MHD were enrolled from seven dialysis units. After adhering to our strategy for one year, serum phosphorus, calcium, intact parathyroid hormone (iPTH), and alkaline phosphatase (AP) levels were compared with the baseline. The endpoint was improvement in the proportion of patients with serum mineral levels at target recommendations. Results: The median serum phosphorus level and proportion of patients with serum phosphorus within the target range were not changed. Although the median serum calcium level was significantly increased, the proportion of patients with serum calcium within the target range was not significantly affected. The proportion of patients with serum iPTH at the target level was not altered, although the median serum iPTH was significantly decreased. However, both median serum AP and the proportion of patients with serum AP at the target level (70.4% vs. 89.6%, P < 0.001) were improved. Conclusion: In our patients with MHD, serum mineral profiles were altered and the serum AP level stabilized after implementing our recommendations. Long-term follow-up evaluations are necessary to determine whether uremic bone disease and cardiovascular calcifications are affected by these recommendations.

Original languageEnglish
Pages (from-to)157-166
Number of pages10
JournalKidney Research and Clinical Practice
Volume37
Issue number2
DOIs
Publication statusPublished - 2018 Jan 1

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Chronic Kidney Disease-Mineral and Bone Disorder
Quality Improvement
Alkaline Phosphatase
Renal Dialysis
Serum
Parathyroid Hormone
Phosphorus
Minerals
Maintenance
Calcium
Guidelines
Bone Diseases
Practice Guidelines

Keywords

  • Alkaline phosphatase
  • Hemodialysis
  • Local adaptation
  • Parathyroid hormone
  • Secondary hyperparathyroidism

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy : A quality improvement study. / Jin, Kyubok; Ban, Tae Hyun; Jung, Ji Yong; Kim, Ae Jin; Kim, Yaerim; Lee, So Young; Yang, Dong Ho; Choi, Bum Soon; Oh, Kook Hwan; Kim, Jieun; Kwon, Young-Joo; Choi, Jong Wook; Kim, Gheun Ho.

In: Kidney Research and Clinical Practice, Vol. 37, No. 2, 01.01.2018, p. 157-166.

Research output: Contribution to journalArticle

Jin, Kyubok ; Ban, Tae Hyun ; Jung, Ji Yong ; Kim, Ae Jin ; Kim, Yaerim ; Lee, So Young ; Yang, Dong Ho ; Choi, Bum Soon ; Oh, Kook Hwan ; Kim, Jieun ; Kwon, Young-Joo ; Choi, Jong Wook ; Kim, Gheun Ho. / Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy : A quality improvement study. In: Kidney Research and Clinical Practice. 2018 ; Vol. 37, No. 2. pp. 157-166.
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T1 - Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy

T2 - A quality improvement study

AU - Jin, Kyubok

AU - Ban, Tae Hyun

AU - Jung, Ji Yong

AU - Kim, Ae Jin

AU - Kim, Yaerim

AU - Lee, So Young

AU - Yang, Dong Ho

AU - Choi, Bum Soon

AU - Oh, Kook Hwan

AU - Kim, Jieun

AU - Kwon, Young-Joo

AU - Choi, Jong Wook

AU - Kim, Gheun Ho

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD. Methods: A total of 355 patients on MHD were enrolled from seven dialysis units. After adhering to our strategy for one year, serum phosphorus, calcium, intact parathyroid hormone (iPTH), and alkaline phosphatase (AP) levels were compared with the baseline. The endpoint was improvement in the proportion of patients with serum mineral levels at target recommendations. Results: The median serum phosphorus level and proportion of patients with serum phosphorus within the target range were not changed. Although the median serum calcium level was significantly increased, the proportion of patients with serum calcium within the target range was not significantly affected. The proportion of patients with serum iPTH at the target level was not altered, although the median serum iPTH was significantly decreased. However, both median serum AP and the proportion of patients with serum AP at the target level (70.4% vs. 89.6%, P < 0.001) were improved. Conclusion: In our patients with MHD, serum mineral profiles were altered and the serum AP level stabilized after implementing our recommendations. Long-term follow-up evaluations are necessary to determine whether uremic bone disease and cardiovascular calcifications are affected by these recommendations.

AB - Background: The aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD. Methods: A total of 355 patients on MHD were enrolled from seven dialysis units. After adhering to our strategy for one year, serum phosphorus, calcium, intact parathyroid hormone (iPTH), and alkaline phosphatase (AP) levels were compared with the baseline. The endpoint was improvement in the proportion of patients with serum mineral levels at target recommendations. Results: The median serum phosphorus level and proportion of patients with serum phosphorus within the target range were not changed. Although the median serum calcium level was significantly increased, the proportion of patients with serum calcium within the target range was not significantly affected. The proportion of patients with serum iPTH at the target level was not altered, although the median serum iPTH was significantly decreased. However, both median serum AP and the proportion of patients with serum AP at the target level (70.4% vs. 89.6%, P < 0.001) were improved. Conclusion: In our patients with MHD, serum mineral profiles were altered and the serum AP level stabilized after implementing our recommendations. Long-term follow-up evaluations are necessary to determine whether uremic bone disease and cardiovascular calcifications are affected by these recommendations.

KW - Alkaline phosphatase

KW - Hemodialysis

KW - Local adaptation

KW - Parathyroid hormone

KW - Secondary hyperparathyroidism

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