2011 Top Game Changers in Nephrology

George Bakris, MD; Jeffrey S. Berns, MD; Lynda A. Szczech, MD; Carol Peckham

Disclosures

November 16, 2011

In This Article

Editor's Note:

The following commentaries, viewpoints, and news stories represent studies or events in 2011 that had a major impact on the field of nephrology. Our Medscape advisors ranked their importance.

10. Aggressive Treatment for Mineral Disorders in CKD -- Useful?

A paper published in JAMA by Palmer and colleagues[1] included a systematic review and meta-analysis of studies that addressed patients with chronic kidney disease (CKD) -- mostly those on hemodialysis and, to a lesser extent, peritoneal dialysis -- and the relationship between calcium, phosphorus, and parathyroid hormone levels and cardiovascular events and mortality. A follow-up comment on this analysis was published in the same issue.[2] In his commentary for Medscape, Jeffrey Berns said, "The study authors found that there was some relationship between phosphorus levels and mortality, ie, higher phosphorus levels were associated with higher mortality, but there was no relationship between parathyroid hormone levels or calcium levels and cardiovascular events or mortality. On the basis of this study and others previously, a strong argument could be made for not targeting therapeutically any particular parathyroid hormone or calcium level in dialysis and CKD patients. There has yet to be a prospective, randomized controlled trial showing that treating phosphorus levels to any particular lower level is associated with any clinical benefit. We need to take a very hard look at what we are doing from a therapeutic standpoint and question whether we should be as aggressive with some of the therapies aimed at fixing mineral metabolism disorders in the absence of evidence that this confers a clinical advantage to our patients."

Watch the complete commentary from Jeffrey Berns, MD.

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