Assessment of bone mineral metabolism derangements by K/DOQI guidelines in haemodialysis patients at Rawalpindi.

OBJECTIVE To assess serum calcium, phosphorus and PTH levels with reference to K/DOQI targets in haemodialysis patients at Rawalpindi. Further more efficacy of calcium carbonate (CaCO3) was compared with calcium acetate (CaAc) for maintaining serum P and Ca levels in our ESRD patients. METHODS One hundred and ninety patients on haemodialysis receiving calcium phosphate binders (CaCO3 n = 128 and CaAc n = 62) were selected from a tertiary care hospital at Rawalpindi, Pakistan. Serum Ca and P were assayed on chemistry analyzer. PTH was measured on immulite-1000. Data were compared with K/DOQI targets and analysed by using SPSS-15. RESULTS The patients had mean serum Ca 2.34 +/- 0.29 mmol/L, Phosphorus 1.76 +/- 0.43 mmol/L and Parathyroid hormone (PTH) 38.7 +/- 35.6 nmol/L. The patients had achieved K/DOQI target ranges of Ca, P, PTH and Ca x P product in 37.9%, 41.1%, 22.6% and 61.5% respectively. Patients on CaCO3 had significantly higher serum Ca 2.38 +/- 0.31 mmol/L than those on CaAc therapy 2.26 +/- 0.22 mmol/L. CONCLUSION Most of patients on maintenance haemodialysis at Rawalpindi, did not achieve the recommended K/DOQI target ranges. Appropriate phosphate binders are required for improvement of mineral metabolism and medical outcome in our patients.