Real-World Doxercalciferol Treatment in SHPT CKD Stage 3 and 4: An Analysis of Change in iPTH and Accordance to KDOQI RecommendationsKumar N. · Lindberg J. · David K. · Morris J. · Menoyo J.
aNephrology and Hypertension, Kidney and Hypertension Center P.C. – Davita Dialysis Unit, Roseburg, Oreg., bNew Orleans Nephrology Associates, New Orleans, La., cProSanos Corp., Harrisburg, Pa., and dGenzyme Corp., Cambridge, Mass., USA
Background: National Kidney Foundation’s Kidney Disease Outcome Quality Initiative (KDOQI) guidelines offer an outline for providing standardized care for best outcomes in chronic kidney disease (CKD). It is unknown whether real-world treatment practices follow these guidelines. Methods: The Hectorol® Registry Outcome in Chronic Kidney Disease (HeROICkd™), an observational patient registry, captured information on adult patients with CKD Stage 3 or 4 throughout US clinics during a 9-month observation period. Data were collected quarterly from patients’ medical records, throughout each patient’s normal treatment course. The proportion of patients with intact parathyroid hormone (iPTH) levels within KDOQI guidelines, change in iPTH, Ca, P, and Ca × P product over the 9-month observation period, incidence of hypercalcemia and hyperphosphatemia, and predictors of change in iPTH were examined. Results: 1,339 CKD Stage 3 and 4 patients from 78 nephrology and internal medicine clinics were included. 40% of CKD Stage 3 participants and 45% of Stage 4 had a 30% or greater reduction in iPTH levels from baseline to 9 months follow-up. While the proportion of CKD Stage 3 and 4 participants with iPTH levels within the KDOQI recommendations improved significantly over the 9 months, it was still modest, at 28% and 23%, respectively. Mean doxercalciferol dose was below that recommended in the package insert and a minority of patients had all mineral metabolism parameters (iPTH, Ca, P) regularly recorded in their medical records. Conclusions: The results of this registry, which examined iPTH treatment with doxercalciferol in CKD Stage 3 and 4, suggest that in the real-world treatment setting, the adherence to KDOQI guidelines is not optimal.
Neil Kumar, MD
Kidney and Hypertension Center P.C.
1632 Hughwood Sq., Suite 3
Roseburg, OR 97470 (USA)
Tel. +1 541 957 1133, Fax +1 541 957 1799, E-Mail email@example.com
The analyses reported here were conducted in ProSanos Corp. facilities.
Received: January 7, 2008
Accepted: May 9, 2008
Published online: August 8, 2008
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 4, Number of References : 16
American Journal of Nephrology
Vol. 29, No. 2, Year 2009 (Cover Date: January 2009)
Journal Editor: Bakris G. (Chicago, Ill.)
ISSN: 0250–8095 (Print), eISSN: 1421–9670 (Online)
For additional information: http://www.karger.com/AJN