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Diagnosis and management of mineral metabolism in CKD.

Publication ,  Journal Article
Bhan, I; Dubey, A; Wolf, M
Published in: J Gen Intern Med
July 2010

BACKGROUND: Chronic kidney disease (CKD) affects over 26 million Americans and is frequently complicated early in its course by disordered mineral metabolism and metabolic bone disease. Since CKD-related bone loss is often indistinguishable from osteoporosis by standard bone densitometry, many CKD patients may be inappropriately treated with bisphosphonates rather than CKD-specific therapies. OBJECTIVE: To determine the prevalence of appropriate evaluation, diagnosis and management of metabolic bone disease among individuals with pre-dialysis CKD. DESIGN AND PARTICIPANTS: Retrospective cohort study using electronic medical records of 69,215 ambulatory patients seen in the primary care clinics of an academic medical center. MEASUREMENTS: Prevalence of CKD stages 3-4, frequency of diagnostic testing and treatment of metabolic bone disease. MAIN RESULTS: Based on current diagnostic criteria and consistent with national data, CKD was present in 12% of the population. Bisphosphonates were used in 7.2% of patients, 20% of whom met criteria for CKD. Fewer than half of CKD patients underwent testing for parathyroid hormone (PTH) or 25-hydroxyvitamin D (25D) levels. Among those tested, vitamin D deficiency (25D <30 ng/ml) and secondary hyperparathyroidism (PTH >60 pg/ml) were present in 65% and 55%, respectively. Among patients with CKD, bisphosphonate use was nearly seven times as frequent as therapy with active vitamin D (12% vs. 1.7%, p < 0.0001), a primary treatment for CKD-associated metabolic bone disease. CONCLUSIONS: Disordered mineral metabolism in CKD is common, under-diagnosed and under-treated. As a result, bisphosphonates may be prescribed inappropriately in patients with CKD.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

July 2010

Volume

25

Issue

7

Start / End Page

710 / 716

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans
  • General & Internal Medicine
  • Female
  • Electronic Health Records
  • Disease Management
 

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Bhan, I., Dubey, A., & Wolf, M. (2010). Diagnosis and management of mineral metabolism in CKD. J Gen Intern Med, 25(7), 710–716. https://doi.org/10.1007/s11606-010-1316-y
Bhan, Ishir, Anil Dubey, and Myles Wolf. “Diagnosis and management of mineral metabolism in CKD.J Gen Intern Med 25, no. 7 (July 2010): 710–16. https://doi.org/10.1007/s11606-010-1316-y.
Bhan I, Dubey A, Wolf M. Diagnosis and management of mineral metabolism in CKD. J Gen Intern Med. 2010 Jul;25(7):710–6.
Bhan, Ishir, et al. “Diagnosis and management of mineral metabolism in CKD.J Gen Intern Med, vol. 25, no. 7, July 2010, pp. 710–16. Pubmed, doi:10.1007/s11606-010-1316-y.
Bhan I, Dubey A, Wolf M. Diagnosis and management of mineral metabolism in CKD. J Gen Intern Med. 2010 Jul;25(7):710–716.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

July 2010

Volume

25

Issue

7

Start / End Page

710 / 716

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans
  • General & Internal Medicine
  • Female
  • Electronic Health Records
  • Disease Management