Serum calcium, phosphate, parathyroid hormone, albumin, aluminium and cholesterol achievement on replacement therapy (Chapter 9)
1Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, Kent CT1 3NG, UK, 2UK Renal Registry, Bristol and 3Leicester General Hospital, Leicester
Correspondence and offprint requests to: Edmund J Lamb, UK Renal Registry, Southmead Hospital, Southmead Rd, Bristol, BS10 5NB, UK. Email: Edmund.lamb{at}ekht.nhs.uk
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Abstract |
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In the UK, there is a continuing year-on-year trend towards improvement in serum phosphate control in dialysis patients although overall it still remains poor. The Renal Association (RA) target (<1.8 mmol/l) was achieved in 65% of patients overall, (71% of peritoneal dialysis (PD) patients, 63% of haemo dialysis (HD) patients).
Seventy-six percent of UK dialysis patients achieve a corrected calcium concentration within the RA target range. As with serum phosphate, there is a trend of continuing year-on-year improvement.
Nearly two-thirds (69%) of patients achieve a calcium x phosphate product within the KDOQI guidelines (<4.4 mmol2/l2): again, achievement seems to have improved year-on-year. Control was better in PD patients compared with HD patients (73% vs 67% achieving the standard).
There remains large between-centre variation in the ability of renal centres to achieve the UK RA target for plasma parathyroid hormone (PTH). As seen in previous years, overall achievement was poor (median 63%, range 47–92% compliance with the standard).
Most transplant patients achieve good phosphate and calcium control (99%, range 95–100%) and the percentage of patients achieving serum calcium concentrations within the target range was 84% (range 43–97%). Nearly all (99%) of transplant patients achieved calcium x phosphate product concentrations within the KDOQI target range.
There would appear to be wide variation in clinical practice with respect to aluminium monitoring with a suggestion that few centres are following current UK, RA guidelines.
Overall in the UK, 83% of HD, 70% of PD and 62% of transplant patients achieve a total cholesterol concentration <5 mmol/l. The percentage of patients with cholesterol <5 mmol/l has increased significantly year-on-year in all three modalities