Comprehensive guidelines lead to better results for patients with mineral, bone disorders
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Kidney disease guidelines paired with checklist and care coordination logs were linked to improved results in patients with mineral and bone disorders, according to a presentation.
“Mineral bone disease is common with end-stage renal disease and leads to bone loss, osteoporosis, fractures and vascular calcifications,” Alpana Pashricha, MD, clinical mentor and medical director, Fresenius Medical Care North Tulsa, and colleagues wrote in their study presented at the American Nephrology Nurses Association National Symposium. “Vascular calcifications and atherosclerosis are leading causes of mortality for end-stage renal disease ... The aim was to increase comprehensive bone mineral care to more than 90% using Kidney Disease Improving Global Outcome (KDIGO) guidelines.”
In four cycles of a rapid plan-study-do-act (PSDA), researchers assessed patients for phosphorus levels and parathyroid hormone levels, as well as readiness to participate in lifestyle changes. Provider documentation of the KDIGO guidelines was also assessed.
Study results showed implementation of the KDIGO guidelines, in association with care coordination from PSDA cycle 1 to cycle 4, led to decreases in phosphorus levels (5.7 mEqL vs. 4.7 mEqL, respectively) and parathyroid hormone levels (433 pg/mL vs. 328 pg/mL, respectively). An increase in mean readiness for lifestyle changes (7.5 vs. 8.7, respectively), as well as a significant improvement in provider documentation, were also observed.
“Improved clinical outcomes means less risk and less consumption of health care resources,” Pashricha and colleagues concluded. “Standardization and checklist improved application of guidelines, clinical outcomes and provider documentation ... These tools should be used in other clinics and other modalities of dialysis.”
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Pashricha A, et al. Implementing Effective Care Using KDIGO Guidelines for Mineral & Bone Disorders in Hemodialysis. Presented at: American Nephrology Nurses Association National Symposium; Aug. 29-31, 2020 (virtual meeting).
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