Clinical Practices and Therapeutic Management of Mineral and Bone Disorders in Chronic Kidney Disease 4, 5 and 5D: The OCEANOS Study in Iran

The aim of this study was to evaluate the management of mineral and bone disorders (MBD) in patients with chronic kidney disease (CKD) in Iran and the extent to which KDIGO goals were met.
This multi-centre observational study was conducted on patients with CKD stages 4, 5, and 5D. Data were collected from a total of 209 patients with no surgical or medical conditions that precluded their participation. This study assessed the frequency of measurements, serum levels of phosphorus (P), calcium (Ca), and parathyroid hormone (PTH), the achievement of the targets recommended by the 2009 KDIGO guidelines, and the presence of vascular/valvular calcification.
The KDIGO targets for P, Ca, and iPTH, were achieved in 47%, 51%, and 18% of the patients with stage 4 5 and in 63%, 50%, and 44% of the patients with stage 5D, respectively. The serum PTH level of 18% of the patients with CKD stage 4 5 was within the recommended range, while it was higher than the recommended level in other patients. Among patients with CKD stage 5D, the serum PTH level was within, below, and above the recommended range in 44%, 39%, and 17% of the patients, respectively. The frequency of the measurement of the blood levels of Ca, P, and PTH were based on the 2009 KDIGO guidelines in 88% of patients. Forty-six percent of cases were screened for vascular/valvular calcification, 30% of whom had calcification at least in one site.
The current status is far from the targets recommended by the current guidelines in the management of CKD-MBD.