Real-world usage of Chronic Kidney Disease - mineral bone disorder (CKD-MBD) biomarkers in nephrology practices
Maria Fusaro, Simona Barbuto, Maurizio Gallieni, Althea Cossettini, Giulia Vanessa Re Sartò, Laura Cosmai, Giuseppe Cianciolo, Gaetano La Manna, Thomas Nickolas, Serge Ferrari, Jordi Bover, Mathias Haarhaus, Carmela Marino, Maria Cristina Mereu, Maura Ravera, Mario Plebani, Martina Zaninotto, Mario Cozzolino, Stefano Bianchi, Piergiorgio Messa, Mariacristina Gregorini, Lorenzo Gasperoni, Caterina Agosto, Andrea Aghi, Giovanni Tripepi- Transplantation
- Nephrology
Abstract
Background
Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications and increase cardiovascular (CV) risk. Nephrologists' awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice.
Methods
a national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by Nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice.
Results
one hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10%. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1%) of both PTH and ALP, 100 (94.3%) of 25(OH)D, and 61 (57.5%) of 1,25(OH)2D; while, most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7% and c-terminal: 93.4%), Klotho (95.3%; soluble form: 97.2%), TRAP-5b (92.5%), CTX (71.7%) and P1NP (88.7%). An interesting data regarding Italian nephrologist's behavior to start treatment of sHPT, the majority of clinicians used KDOQI guidelines (n = 55, 51.9%). In contrast, only 40 nephrologists (37.7%) relied on KDIGO guidelines which recommended referring to values of PTH between 2 and 9 times the upper limit of the normal range.
Conclusion
Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.