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Title:           Real-world usage of Chronic Kidney Disease – Mineral Bone Disorder (CKD–MBD) biomarkers in nephrology practices
Subject:         DOI: 10.1093/ckj/sfad290 Clinical Kidney Journal, 17, 1, 29-11-2023. Abstract: Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications, and increase cardiovascular (CV) risk. Nephrologists’ awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice.A national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice.One hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10%. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1%) of both PTH and alkaline phosphatase (ALP), 100 (94.3%) of 25(OH)D, and 61 (57.5%) of 1.25(OH)2D; while most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7% and c-terminal: 93.4%), Klotho (95.3%; soluble form: 97.2%), tartrate-resistant acid phosphatase 5b (TRAP-5b) (92.5%), C-terminal telopeptide (CTX) (71.7%), and pro-collagen type 1 N-terminal pro-peptide (P1NP) (88.7%). As interesting data regarding Italian nephrologists’ behavior to start treatment of secondary hyperparathyroidism (sHPT), the majority of clinicians used KDOQI guidelines (n = 55, 51.9%). In contrast, only 40 nephrologists (37.7%) relied on KDIGO guidelines, which recommended referring to values of PTH between two and nine times the upper limit of the normal range.Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.
Keywords:        bone biomarkers, bone fractures, bone turnover markers, CKD-MBD, vascular calcifications
Author:          Fusaro Maria, Barbuto Simona, Gallieni Maurizio, Cossettini Althea, Re Sartò Giulia Vanessa, Cosmai Laura, Cianciolo Giuseppe, La Manna Gaetano, Nickolas Thomas, Ferrari Serge, Bover Jordi, Haarhaus Mathias, Marino Carmela, Mereu Maria Cristina, Ravera Maura, Plebani Mario, Zaninotto Martina, Cozzolino Mario, Bianchi Stefano, Messa Piergiorgio, Gregorini Mariacristina, Gasperoni Lorenzo, Agosto Caterina, Aghi Andrea, Tripepi Giovanni
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    Title: Real-world usage of Chronic Kidney Disease – Mineral Bone Disorder (CKD–MBD) biomarkers in nephrology practices
    Author: Fusaro Maria, Barbuto Simona, Gallieni Maurizio, Cossettini Althea, Re Sartò Giulia Vanessa, Cosmai Laura, Cianciolo Giuseppe, La Manna Gaetano, Nickolas Thomas, Ferrari Serge, Bover Jordi, Haarhaus Mathias, Marino Carmela, Mereu Maria Cristina, Ravera Maura, Plebani Mario, Zaninotto Martina, Cozzolino Mario, Bianchi Stefano, Messa Piergiorgio, Gregorini Mariacristina, Gasperoni Lorenzo, Agosto Caterina, Aghi Andrea, Tripepi Giovanni
    Subject: DOI: 10.1093/ckj/sfad290 Clinical Kidney Journal, 17, 1, 29-11-2023. Abstract: Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications, and increase cardiovascular (CV) risk. Nephrologists’ awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice.A national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice.One hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10%. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1%) of both PTH and alkaline phosphatase (ALP), 100 (94.3%) of 25(OH)D, and 61 (57.5%) of 1.25(OH)2D; while most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7% and c-terminal: 93.4%), Klotho (95.3%; soluble form: 97.2%), tartrate-resistant acid phosphatase 5b (TRAP-5b) (92.5%), C-terminal telopeptide (CTX) (71.7%), and pro-collagen type 1 N-terminal pro-peptide (P1NP) (88.7%). As interesting data regarding Italian nephrologists’ behavior to start treatment of secondary hyperparathyroidism (sHPT), the majority of clinicians used KDOQI guidelines (n = 55, 51.9%). In contrast, only 40 nephrologists (37.7%) relied on KDIGO guidelines, which recommended referring to values of PTH between two and nine times the upper limit of the normal range.Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.
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               <rdf:li xml:lang="x-default">DOI: 10.1093/ckj/sfad290 Clinical Kidney Journal, 17, 1, 29-11-2023. Abstract: Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications, and increase cardiovascular (CV) risk. Nephrologists&amp;#x2019; awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice.A national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice.One hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10&amp;#x0025;. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1&amp;#x0025;) of both PTH and alkaline phosphatase (ALP), 100 (94.3&amp;#x0025;) of 25(OH)D, and 61 (57.5&amp;#x0025;) of 1.25(OH)2D; while most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7&amp;#x0025; and c-terminal: 93.4&amp;#x0025;), Klotho (95.3&amp;#x0025;; soluble form: 97.2&amp;#x0025;), tartrate-resistant acid phosphatase 5b (TRAP-5b) (92.5&amp;#x0025;), C-terminal telopeptide (CTX) (71.7&amp;#x0025;), and pro-collagen type 1 N-terminal pro-peptide (P1NP) (88.7&amp;#x0025;). As interesting data regarding Italian nephrologists&amp;#x2019; behavior to start treatment of secondary hyperparathyroidism (sHPT), the majority of clinicians used KDOQI guidelines (n&amp;#x00A0;&amp;#x003D;&amp;#x00A0;55, 51.9&amp;#x0025;). In contrast, only 40 nephrologists (37.7&amp;#x0025;) relied on KDIGO guidelines, which recommended referring to values of PTH between two and nine times the upper limit of the normal range.Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.</rdf:li>
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