%0 Generic
%A N.S., Roetker
%A Y., Peng
%A A., Ashfaq
%A D.T., Gilbertson
%A J.B., Wetmore
%D 2019
%T Supplementary Material for: Adherence to Kidney Disease: Improving Global Outcomes Mineral and Bone Guidelines for Monitoring Biochemical Parameters
%U https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Adherence_to_Kidney_Disease_Improving_Global_Outcomes_Mineral_and_Bone_Guidelines_for_Monitoring_Biochemical_Parameters/7745735
%R 10.6084/m9.figshare.7745735.v1
%2 https://karger.figshare.com/ndownloader/files/14413421
%2 https://karger.figshare.com/ndownloader/files/14413424
%2 https://karger.figshare.com/ndownloader/files/14413427
%2 https://karger.figshare.com/ndownloader/files/14413430
%2 https://karger.figshare.com/ndownloader/files/14413433
%2 https://karger.figshare.com/ndownloader/files/14413436
%2 https://karger.figshare.com/ndownloader/files/14413439
%K 25-hydroxyvitamin D
%K Calcium
%K Laboratory testing
%K Parathyroid hormone
%K Phosphorus
%X Background: Mineral and bone disorder (MBD) is common in patients with chronic kidney disease (CKD), and is associated with risk of fractures, cardiovascular disease, and death. Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend monitoring CKD-MBD biochemical markers, including parathyroid hormone (PTH), phosphorus, 25-hydroxyvitamin D (25D), calcium, and alkaline phosphatase (ALP), in patients with moderate-to-severe CKD. Methods: To determine guideline adherence, we used administrative claims records from the 20% sample of Medicare beneficiaries with Parts A, B, and D coverage, 2007 to 2015, and identified cohorts of patients with nondialysis stage 3, 4, or 5 CKD. Testing for biochemical markers during follow-up was defined based on laboratory procedure codes. Baseline factors associated with laboratory testing were determined using logistic regression. All analyses were performed separately by CKD stage. Results: A total of 640,946 stage 3, 136,278 stage 4, and 22,076 stage 5 CKD patients, 50.2–52.9% women, mean age 74.4–78.0 years, were followed for a mean of 2.5, 1.3, and 0.7 years respectively. The frequency of testing was low for PTH (35.2–48.2%), phosphorus (46.6–62.0%), and 25D (29.3–46.7%). Testing was somewhat higher for calcium (88.1–95.4%) and ALP (63.5–88.1%); most tests were features of larger panels (e.g., basic metabolic panel). Older age, most comorbid conditions, and lack of prior nephrology care were associated with lower likelihood of testing. Conclusions: In fee-for-service Medicare beneficiaries, laboratory testing for CKD-MBD biochemical markers appears to be suboptimal in relation to KDIGO guidelines. Competing priories, such as management of comorbid disease and preparation for renal replacement therapy, may distract from CKD-MBD monitoring.
%I Karger Publishers