Abstract: SA-PO701
Secondary Hyperparathyroidism: Are KDIGO Guidelines for PTH Testing Being Followed?
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Roetker, Nicholas S., Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
- Peng, Yi, Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Ashfaq, Akhtar, OPKO Health, Miami, Florida, United States
- Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background
KDIGO recommends that patients with chronic kidney disease (CKD) undergo parathyroid hormone (PTH) testing beginning in CKD stage 3 followed by testing in stage 4 (every 6-12 months) and in stage 5 (every 3-6 months). KDIGO also suggests a role for 25-hydroxyvitamin D [25(OH)D] testing, although frequency is not specified. Adherence to these guidelines is unknown.
Methods
Using the 2007-2015 20% Medicare sample, we identified a cohort of patients with stage 3, 4, or 5 CKD. CKD stage was determined by presence of two or more claims with ICD-9-CM codes for CKD. Only patients with 30 or more days of follow-up were included. Frequency of 25(OH)D and PTH testing was identified using laboratory procedure codes. Factors associated with PTH testing by each CKD stage were then determined using separate logistic regression models.
Results
A total of 381,332 (stage 3), 86,875 (stage 4), and 14,401 (stage 5) CKD patients were identified. Over mean follow-up of 2.3 ± 1.8 (stage 3), 1.3 ± 1.3 (stage 4), and 0.7 ± 0.9 (stage 5) years, 54% of stage 3, 61% of stage 4, and 70% of stage 5 patients were not tested for 25(OH)D deficiency; corresponding percentages for PTH were 66%, 56%, and 52%, respectively (Table). Factors inversely associated with PTH testing were older age and presence of most comorbid conditions.
Conclusion
Testing for 25(OH)D deficiency was relatively infrequent. PTH testing was undertaken less than half as often as is recommend by KDIGO guidelines. This is potentially concerning, especially since recent data indicate it can be challenging to achieve PTH targets even with routine testing. How the uncertainty over optimal PTH targets in CKD, as discussed in the current KDIGO guidelines, will affect future testing patterns, should be studied.
Funding
- Commercial Support – OPKO Pharmaceuticals, LLC