Aggressive Treatment for Mineral Disorders in CKD -- Useful?
Aggressive Treatment for Mineral Disorders in CKD -- Useful?
Hello. This is Jeffrey Berns from the University of Pennsylvania School of Medicine in Philadelphia. I am Editor-in-Chief of Medscape Nephrology. I would like to call your attention to a paper that was recently published in JAMA by Palmer and colleagues. It includes a systematic review and meta-analysis of studies that address chronic kidney disease (CKD) patients -- mostly patients on hemodialysis, and to a lesser extent, peritoneal dialysis -- and the relationship between calcium, phosphorus, and parathyroid hormone levels with cardiovascular events and mortality. The study authors found that there was some relationship between phosphorus levels and mortality, ie, higher phosphorus levels were associated with higher mortality, but there was no relationship between parathyroid hormone levels or calcium levels and cardiovascular events or mortality.
This is a topic that I have addressed in video blogs before. It is an important one and points out how little we really know about what we are doing therapeutically in this regard. On the basis of this study and others previously, a strong argument could be made for not targeting therapeutically any particular parathyroid hormone level or calcium level in dialysis and CKD patients. As I have discussed here before, I think there has yet to be a prospective, randomized controlled trial showing that treating phosphorus levels to any particular lower level is associated with any clinical benefit. So we really have a conundrum here. We spend lots of time and money getting our patients to take phosphate binders, calcium supplements, vitamin D, and calcimimetics, although it is not clear that this is associated with a clinical benefit in terms of...mortality and cardiovascular events. Also, there may not be some benefits to these therapies beyond correcting laboratory abnormalities, but this remains unproven.
I think we need to take a very hard look at what we are doing from a therapeutic standpoint and question whether we should be as aggressive with some of the therapies aimed at fixing mineral metabolism disorders in the absence of evidence that this confers a clinical advantage to our patients. Take a look at this paper and the accompanying editorial. If you have any comments, please submit them through the Medscape video blog site.
Thanks for your attention. Again, this is Jeffrey Berns from the University of Pennsylvania School of Medicine in Philadelphia.
Hello. This is Jeffrey Berns from the University of Pennsylvania School of Medicine in Philadelphia. I am Editor-in-Chief of Medscape Nephrology. I would like to call your attention to a paper that was recently published in JAMA by Palmer and colleagues. It includes a systematic review and meta-analysis of studies that address chronic kidney disease (CKD) patients -- mostly patients on hemodialysis, and to a lesser extent, peritoneal dialysis -- and the relationship between calcium, phosphorus, and parathyroid hormone levels with cardiovascular events and mortality. The study authors found that there was some relationship between phosphorus levels and mortality, ie, higher phosphorus levels were associated with higher mortality, but there was no relationship between parathyroid hormone levels or calcium levels and cardiovascular events or mortality.
This is a topic that I have addressed in video blogs before. It is an important one and points out how little we really know about what we are doing therapeutically in this regard. On the basis of this study and others previously, a strong argument could be made for not targeting therapeutically any particular parathyroid hormone level or calcium level in dialysis and CKD patients. As I have discussed here before, I think there has yet to be a prospective, randomized controlled trial showing that treating phosphorus levels to any particular lower level is associated with any clinical benefit. So we really have a conundrum here. We spend lots of time and money getting our patients to take phosphate binders, calcium supplements, vitamin D, and calcimimetics, although it is not clear that this is associated with a clinical benefit in terms of...mortality and cardiovascular events. Also, there may not be some benefits to these therapies beyond correcting laboratory abnormalities, but this remains unproven.
I think we need to take a very hard look at what we are doing from a therapeutic standpoint and question whether we should be as aggressive with some of the therapies aimed at fixing mineral metabolism disorders in the absence of evidence that this confers a clinical advantage to our patients. Take a look at this paper and the accompanying editorial. If you have any comments, please submit them through the Medscape video blog site.
Thanks for your attention. Again, this is Jeffrey Berns from the University of Pennsylvania School of Medicine in Philadelphia.