Mineral and Bone Metabolism Disorders in Minority Incident ESRD Patients in an Inner-City Hemodialysis Unit

Background : Chronic kidney disease (CKD) predisposes patients to mineral and bone metabolism disorder (CKD- MBD), which is a well-known risk factor for increased mortality. Because Medical Evidence Form 2728 from the Centers for Medicare and Medicaid Services for incident end-stage renal disease (ESRD) patients does not require documentation of CKD-MBD markers, MBD status on incident patients remains unknown. Objective : Retrospective observational study to determine the prevalence of mineral and bone metabolism disorder in minority incident ESRD patients. Methods : We studied all incident ESRD patients in our hemodialysis unit between January 2000 and September 2008. Patients followed for less than three months were excluded. Target values for CKD stage 5 were defined as per 2003 Kidney Disease Outcome Quality Initiative guidelines. Results : One hundred seventy-four patients were stud- ied, with a mean age of 53.7±16.1 years, mean body mass index of 26.67±5.98 kg/m 2 , and mean estimated glomerular filtration rate of 6.7±4.03 mL/min/1.73m 2 . Mean lab values with one standard deviation were as follows: corrected calcium 8.5±1.3 mg/dL, serum albumin 3.05±0.77 g/dL, phosphorus 5.5±2.2 mg/dL, calcium-phosphorus product 46.7±18.5 mg 2 /dL 2 , and intact parathyroid hormone (iPTH) 440.9±397.8 pg/mL. Target values for cal- cium, phosphorus, calcium-phosphorus product, and iPTH were met in 34%, 42%, 72%, and 31% of the patients, respectively, while only 6% of the patients met all four target values. Conclusions : CKD-MBD is widely prevalent in minority incident dialysis patients at initiation of therapy. Its management continues to be a challenge and warrants early recognition and therapy in CKD patients.