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[How to reach and maintain the K/DOQI recommendations for bone and mineral metabolism in patients undergoing haemodialysis: an efficient strategy].

INTRODUCTION
Recent publications have indicated that alterations in bone and mineral metabolism are known to participate to a high mortality rate in patients undergoing haemodialysis. A new therapeutic strategy is progressively undertaken in the dialysis unit over a 36 months period covering years 2002 to 2004.


METHODS
This new strategy includes the prescription of non-calcium, non-aluminium phosphate binder, sevelamer hydrochloride, an increase in vitamin D analogues prescription and a moderation in calcium carbonate administration. Sixty patients participated to the entire study and are evaluated three times a year on the four K/DOQI parameters. Other indicators such as haemoglobin, bicarbonate, total cholesterol and HDL cholesterol levels were studied.


RESULTS
At the beginning of the study, 7% of the patients achieved the four K/DOQI parameters. This proportion seemed identical to those observed in the major studies. But progressively with the new therapeutic strategy 13%, then 21%, and at the end of the study 35% reached the four criteria. Therapeutic calcium intakes decreased from 100 g per patient/month to 28 g per patient-month. Prescription of vitamin D analogues increased from 3.3 microg per patient-month to 18.3 microg per patient/month. At the end of the study 60% of the patients received sevelamer hydrochloride at the mean dosage of 4800 mg per day. Haemoglobin remains stable. Bicarbonate level decreased due to a minor prescription in calcium carbonate. Under statins the ratio total cholesterol/HDL cholesterol decreased to 3.3.


CONCLUSION
A modification in the therapeutic strategy offer to patients undergoing haemodialysis, the possibility to achieve the K/DOQI recommendations with the hope to obtain a beneficial effect on patient outcomes.