Prevalence of chronic kidney disease-mineral and bone disorder in incident peritoneal dialysis patients and its association with short-term outcomes

Abstract

Introduction: A complex relationship exists between chronic kidney disease-mineral and bone disorder (CKD-MBD) and adverse outcomes among dialysis patients. This study aimed to report the prevalence of CKD-MBD and examine the impact of achieving target CKD-MBD parameters on morbidity and mortality one year after peritoneal dialysis (PD) initiation.

Methods: In this retrospective cohort study, patients electively initiated on PD were followed up for one year. Laboratory parameters were collected and the prevalence of CKD-MBD 4-6 months after PD initiation was determined based on the Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Linear regression and Cox proportional hazards model were used to evaluate the effects of achieving CKD-MBD targets 4-6 months after PD initiation on hospitalisation, the incidence of peritonitis or exit-site infections (ESIs), and mortality at one year.

Results: The prevalence of CKD-MBD among the 86 patients in this study was 86.0% (KDOQI) and 54.7% (KDIGO). There was no significant difference in hospitalisation duration between patients who achieved targets and those who did not. Patients who failed to meet all the KDIGO CKD-MBD or calcium serum targets had a higher incidence of peritonitis or ESI. A trend toward shorter time to death was observed among patients who failed to meet the KDIGO phosphorus serum targets.

Conclusion: There was moderate (KDIGO) to high prevalence (KDOQI) of CKD-MBD among the patients. Achievement of all the KDIGO CKD-MBD or calcium serum targets was associated with reduced peritonitis or ESI, while achievement of the KDIGO phosphorus serum targets was associated with improved survival.

Keywords: incident; mineral and bone disorder; outcomes; peritoneal dialysis; short-term.

Fig. 1

Flow chart shows the selection of incident peritoneal dialysis patients for inclusion in the study.

Fig. 2

Bar graph shows the prevalence of chronic kidney disease-mineral and bone disorder after the initiation of peritoneal dialysis (PD) based on the Kidney Disease: Improving Global Outcomes (KDIGO) and Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.

Fig. 3

Bar graph shows the percentage of peritoneal dialysis (PD) patients who achieved the chronic kidney disease-mineral and bone disorder targets recommended by the Kidney Disease Outcomes Quality Initiative (KDOQI) and the Kidney Disease: Improving Global Outcomes (KDIGO) at one month (1M) and 4–6 months (4M) after the initiation of PD. Ca: calcium; i-PTH: intact parathyroid hormone; P: phosphate

Fig. 4

Adjusted Cox proportional hazards model shows the difference in time to death between peritoneal dialysis patients who met the Kidney Disease: Improving Global Outcomes (KDIGO) target for phosphate and those who did not.