Pattern of Laboratory Parameters and Management of Secondary Hyperparathyroidism in Countries of Europe, Asia, the Middle East, and North America

Abstract

Introduction: This analysis explored laboratory mineral and bone disorder parameters and management of secondary hyperparathyroidism in patients undergoing hemodialysis in Belgium, Canada, China, France, Germany, Italy, Japan, Russia, Saudi Arabia, Spain, Sweden, the UK, and the USA.

Methods: Analyses used demographic, medication, and laboratory data collected in the prospective Dialysis Outcomes and Practice Patterns Study (2012-2015). The analysis included 20,612 patients in 543 facilities. Descriptive data are presented as regional mean (standard deviation), median (interquartile range), or prevalence, weighted for facility sampling fraction. No testing of statistical hypotheses was conducted.

Results: The frequency of serum intact parathyroid hormone levels > 600 pg/mL was lowest in Japan (1%) and highest in Russia (30%) and Saudi Arabia (27%). The frequency of serum phosphorus levels > 7.0 mg/dL was lowest in France (4%), the UK (6%), and Spain (6%), and highest in China (27%). The frequency of serum calcium levels > 10.0 mg/dL was highest in the UK (14%) and China (13%) versus 2% to 9% elsewhere. Dialysate calcium concentrations of 2.5 mEq/mL were common in the USA (78%) and Canada (71%); concentrations of 3.0-3.5 mEq/L were almost universal at facilities in Italy, France, and Saudi Arabia (each ≥ 99%).

Conclusions: Wide international variation in mineral and bone disorder laboratory parameters and management practices related to secondary hyperparathyroidism suggests opportunities for optimizing care.

Keywords: Bone mineral density; CKD; Dialysis; ESRD; Hyperparathyroidism; Mineral metabolism.

Fig. 1

Dialysate calcium values by DOPPS country (2012–2015), weighted by facility sampling fraction and sorted by proportion of patients in category of 2.5 mEq/L. Bel Belgium, Can Canada, Chi China, DOPPS Dialysis Outcomes and Practice Patterns Study, Eq equivalent, Fra France, Ger Germany, Ita Italy, Jpn Japan, KSA Kingdom of Saudi Arabia, pt patient, Rus Russia, Spa Spain, Swe Sweden

Fig. 2

Serum concentrations of MBD-related laboratory assessments by DOPPS country (2012–2015), weighted by facility sampling fraction and sorted by proportion of patients in the highest category. a iPTH. b Phosphorus. c Total calcium. Bel Belgium, Can Canada, Chi China, DOPPS Dialysis Outcomes and Practice Patterns Study, Fra France, Ger Germany, Ita Italy, Jpn Japan, KSA Kingdom of Saudi Arabia, MBD mineral and bone disorder, pt patient, iPTH intact parathyroid hormone, Rus Russia, Spa Spain, Swe Sweden

Fig. 3

Distribution of the percentage of patients in each facility who had a serum laboratory assessment higher than the upper limit value by DOPPS country (2012–2015), sorted by median proportion of patients. a iPTH > 600 pg/mL. b Phosphorus > 6 mg/dL. Bel Belgium, Can Canada, Chi China, DOPPS Dialysis Outcomes and Practice Patterns Study, Fac facility, Fra France, Ger Germany, Ita Italy, Jpn Japan, KSA Kingdom of Saudi Arabia, pt patient, iPTH intact parathyroid hormone, Rus Russia, Spa Spain, Swe Sweden. *Restricted to facilities with ≥ 10 non-missing values for the laboratory assessment of interest

Fig. 4

MBD lower and upper targets for serum concentrations of laboratory assessments, as reported by medical directors by DOPPS country or region (2012–2015). a iPTH, pg/mL. b Phosphorus, mg/dL. c Total calcium, mg/dL. DOPPS Dialysis Outcomes and Practice Patterns Study, MBD mineral and bone disease, iPTH intact parathyroid hormone. Europe includes Belgium, France, Germany, Italy, Spain, Sweden, and the UK. North America includes Canada and the USA