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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2016  |  Volume : 27  |  Issue : 2  |  Page : 290-304
Multinational observational study on clinical practices and therapeutic management of mineral and bone disorders in patients with chronic kidney disease stages 4, 5, and 5D: The OCEANOS study

1 Saudi Center for Organ Transplantation, Riyadh, Kingdom of Saudi Arabia
2 Al-Qassimi Hospital, Sharjah, United Arab Emirates
3 Al Hussien University Hospital, Al Azhar University, Cairo, Egypt
4 The Aga Khan University Hospital, Karachi, Pakistan
5 Extracorporeal Hemocorrection Unit, Astana, Kazakhstan
6 Kazakh National Medical University, Almaty, Kazakhstan
7 Department of Nephrology, Research Unit UR12ES14, H. Chaker University Hospital, Sfax University, Sfax, Tunisia
8 Department of Nephrology, Labbafinejad Hospital, Tehran, Iran

Correspondence Address:
Faissal A. M. Shaheen
Saudi Center for Organ Transplantation, P. O. Box 27049, Riyadh 11417
Kingdom of Saudi Arabia
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DOI: 10.4103/1319-2442.178266

PMID: 26997382

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Our aim is to assess the current clinical practices in monitoring and treatment patterns of chronic kidney disease (CKD)-mineral bone disorder and the degree to which these practices met the kidney disease improving global outcome (KDIGO) guidelines. This was an international, multi-center, cross-sectional, observational study in adult patients diagnosed with CKD Stages 4, 5, and 5D. Patients were enrolled from Middle East, South Asia, Eurasia, and Africa; patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m 2 or with any medical/surgical conditions precluding their participation were excluded. Frequency of measurements, levels of serum calcium (Ca), phosphorus and parathormone (parathyroid hormone [PTH], and presence vascular/valvular calcification were recorded. Of the 2250 patients enrolled, data on 2247 patients were evaluated. Overall, only a small percentage of patients met all three target KDIGO ranges of serum Ca, phosphorus, and PTH (13.7% [95% confidence interval: 12.0; 15.4], with a higher proportion among CKD Stage 5D patients (14.8%) than CKD Stage 4 and 5 (5.6%) patients. Majority (84.3%) of the patients received treatment with phosphorous binders, of whom 85.5% received Ca-based phosphate binders. Overall, 57.0% of patients received Vitamin D treatment with a similar frequency among patients with CKD Stages 4, 5, and 5D. Over half (65.7%) of the patients were screened for vascular/valvular calcification; of these, 58.8% had ≥1 calcification. Diabetes status, P, PTH, and low density lipoprotein-cholesterol had significant impact on the prescription pattern of phosphorous binders. The current practices for the management of bone and mineral metabolism in CKD patients in the study region fall far short of meeting the KDIGO target range.

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