Real-world usage of Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) biomarkers in nephrology practices.
A national survey of nephrologists found marked heterogeneity and suboptimal guideline implementation in the real-world use of CKD-Mineral Bone Disorder (CKD-MBD) biomarkers, with routine reliance on standard markers but limited availability of newer bone turnover markers.
Background
CKD-MBD involves disturbances of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that promote bone disease, vascular calcification, and increased cardiovascular risk. Appropriate use of diagnostic, prognostic, and therapeutic tools is central to managing the condition, but the extent to which nephrologists apply guideline-recommended biomarker monitoring in routine practice is uncertain.
Study design
The investigators launched a national survey composed of 15 closed questions to assess how nephrologists use bone biomarkers in managing CKD-MBD and to gauge implementation of guideline recommendations. One hundred and six Italian nephrologists responded, an overall response rate of approximately 10 percent.
Key findings
Local laboratories reliably supported standard markers, with 99.1 percent able to provide both PTH and alkaline phosphatase and 94.3 percent able to provide 25(OH)D, whereas most could not provide newer markers such as FGF-23, Klotho, TRAP-5b, CTX, and P1NP. For initiating treatment of secondary hyperparathyroidism, 51.9 percent of clinicians used KDOQI guidelines and only 37.7 percent relied on KDIGO guidance, reflecting inconsistent thresholds for action.
Clinical implications
The findings reveal substantial heterogeneity in CKD-MBD management and suboptimal uptake of guidelines in clinical practice, driven in part by limited laboratory availability of emerging biomarkers. The authors frame the survey as a starting point for efforts to standardize practice and improve awareness of diagnostic and therapeutic tools, though results derive from a single-country sample with a low response rate.
Category
Research
Source
Clin Kidney J
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