Abstract
MBD-5D (mineral and bone disorders outcomes study for Japanese chronic kidney disease stage 5D patients) was a prospective multicenter observational study in hemodialysis patients with secondary hyperparathyroidism (SHPT) conducted between January 2008 and January 2011 with the participation of large dialysis facilities in Japan. Investigation of the impact of practice patterns at these facilities on the outcomes of SHPT patients is one of the aims of the study and the practice patterns at the start and the end of the study were investigated. Eighty-five facilities (98.8%) responded to the survey on practice patterns at the start of the study. We report here the survey results focusing on compliance with the “Guidelines for the management of secondary hyperparathyroidism in chronic dialysis patients” published in 2006 by the Japanese Society for Dialysis Therapy (JSDT) and patterns of drug administration for MBD. At 95.3% of the facilities, serum phosphorus (P) and calcium (Ca) levels were measured at the frequency recommended by the Guidelines (at least once to twice a month) and 64.7% of the facilities measured parathyroid hormone (PTH) at the recommended frequency (once every 3 months). Management target values (lower limit to upper limit) for corrected serum Ca level, serum P level and serum intact PTH level were within the target ranges of the Guidelines in 60.0%, 71.8% and 54.1% of the facilities, respectively. The survey demonstrated the patterns of drug administration to treat MBD, including calcium carbonate, sevelamer hydrochloride and active vitamin D as proposed by the Guidelines, as well as cinacalcet hydrochloride, which was launched after establishment of the Guidelines. This survey documented current practice patterns including advances in MBD management that have developed after the Guidelines were published. These current practice patterns are expected to be considered during future revision of the Guidelines.
