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Xue-Qing Yu, MD, Phd Kdigofellowship Training Under Prof Robert C Atkins in 1996 and Senior Visiting Scholarship Under Prof Richard Johnson in 2002

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Xue-Qing Yu, MD, Phd Kdigofellowship Training Under Prof Robert C Atkins in 1996 and Senior Visiting Scholarship Under Prof Richard Johnson in 2002 Ø Dr. Xue-Qing Yu is the Director of Institute of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. He is Changjiang Scholarship Professor, Ministry of Education. Ø His academic positions include President of Chinese Society of Nephrology, Chairman of Membership Committee of ISPD, Executive Member of APSN, Associate Editor of AJKD, and Subject Editor of Nephrology. He received his Xue-Qing Yu, MD, PhD KDIGOfellowship training under Prof Robert C Atkins in 1996 and senior visiting scholarship under Prof Richard Johnson in 2002. CKD-MBD in China Current and Perspective Xueqing YU, MD PhD Department of Nephrology The First AffiliatedKDIGO Hospital of Sun Yat-sen University Guangzhou, China KDIGO • P ↑, FGF-23 ↑, PTH ↑ • 1, 25 (OH) 2D3 ↓ , Ca ↓ Kidney International (2009) 76 (Suppl 113), S3-S8. CKD-MBD: Common Cause of Death on dialysis patients CKD MDBKDIGO Anemia Inadquency a serum P ≥5 mg/dL, serum calcium ≥10 mg/dL, PTH≥600 pg/mL中的一项或多项 A retrospective study with 40,538 MHD patients and followed up 12-18 M Conclusion: CKD-MBD caused detah: 17.5%，3 times higher than inadequacy and 1.5 times than anemia Block GA, Klassen PS, Lazarus JM, et al. J Am Soc Nephrol. 2004;15(8):2208-2218. Phosphate Level on All cause and CVD mortality （2008） 925 units, 25,588 ESRD received dialysis more than 180 days KDIGO Tentori F, et al. Am J Kidney Dis. 2008;52:519-530. Vascular calcification remarkably increases the mortality of dialysis patients KDIGO Block GA, Raggi P, Bellasi A, et al. Kidney Int. 2007;71:438-441 Outlines • The prevalence of CKD-MBD in CKD patients • Risk factors and effects on patients’ outcome • Treatment of CKD-MBD:KDIGO Current and challenge Serum Phosphorus by Country Serum– DOPPS Phosphorus 4 (2009-2011)* by Country – DOPPS 4 (2009-2011)* < 3.5 mg/dl 3.5-4.5 mg/dl 4.6-5.5 mg/dl % of Patients 5.6-7.0 mg/dl > 7.0 mg/dl 100 5 7 9 6 9 12 13 13 14 12 17 18 19 24 30 20 22 21 75 24 23 24 32 31 26 26 24 25 28 27 28 50 25 26 28 24 33 34 34 30 27 19 25 24 23 25 KDIGO24 25 20 19 14 19 18 19 16 16 16 15 14 9 10 0 7 5 SP BE UK FR IT ANZ SW CA US GE JP CH * Data are from the initial prevalent cross-section of patients in each country The Prevalence of Hyperphosphatemia of Dialysis The PrevalencePatients of Hyperphosphatemia in China: 78% of Dialysis Patients in China: 78% Patients percent (%) KDIGO SP BE UK FR IT ANZ SW CA US GE JP CH Mean (mg/dL) = 4.6 4.8 4.8 4.7 4.9 5.0 5.1 5.2 5.3 5.7 5.5 6.2 * Data are from the initial prevalent cross-section of patients Distribution of facility % of patients with Facility % of PatientsPhosphorus 3.5-5.5 mg/dL* 90 80 70 60 Percentile 95th 50 75th 40 50th 30 25th 20 KDIGO 5th 10 0 BE SP US IT FR JP UK ANZ CA SW GE CH • KDOQI guidelines; Restricted to initial cross-section of patients in facilities with at least 5 patients with non-missing phosphorus data; DOPPS 4 (2009-2011) Serum Calcium by Country DOPPS 4 (2009-2011)* % of Patients < 8.4 mg/dl 8.4-9.5 mg/dl 9.6-10.2 mg/dl > 10.2 mg/dl 100 10 5 6 10 7 10 6 9 7 8 20 18 24 17 21 22 19 19 23 27 75 25 28 28 42 50 47 55 58 53 55 59 50 56 54 54 40 25 KDIGO 33 24 23 19 19 17 15 13 13 12 12 10 0 1 CH GE BE IT SP CA US UK JP FR ANZ SW * Data are from the initial prevalent cross-section of patients in each country; Calcium is albumin corrected Serum PTH by Country DOPPS (2009-2011)* <150 pg/mL 150-299 pg/mL 300-449 pg/mL % of Patients 450-599 pg/mL 600+ pg/mL 100 2 11 10 9 9 8 3 17 14 12 19 7 8 24 23 7 9 9 11 8 9 7 11 16 75 17 14 28 13 12 17 18 17 16 19 19 13 17 34 33 31 37 29 50 25 30 22 24 37 30 60 25 KDIGO 34 35 27 33 31 31 32 33 31 18 21 0 ANZ CA CH UK US FR SW IT SP BE GE JP * Data are from the initial prevalent cross-section of patients in each country Serum PTH by Country DOPPS (2009-2011)* High Percentage of Patients with PTH＞ 600pg/mL 600pg/m (%) ＞ KDIGO Patient percent with Patient percent with PTH JP GE BE SP IT SW FR US UK CH CA ANZ Mean (pg/mL) = 162 279 281 290 295 299 327 366 363 394 446 445 Phosphate Binder Prescription by Country % of PAtients DOPPS (2009-2011)* 100 88 87 90 82 81 81 80 80 79 78 78 80 77 70 60 51 50 40 30 20 KDIGO 10 0 CA SW JP US IT GE SP BE UK ANZ FR CH * Data are from the initial prevalent cross-section of patients in each country; Yellow bars extend to calculated prevalence if missing data classified as ‘No’ prescription (% missing for ESA ranges from 14.6% in China to 0.3% in Germany) Phosphate Binder Formulations by Country DOPPS 4 (2010-2011)* % of Patients Ca-based only Sevelamer only Ca-based+Sevelamer Lanthanum only Other combination 100 4 8 1 9 8 13 11 10 2 5 16 19 27 8 30 15 4 15 31 11 23 13 75 23 6 22 20 3 11 6 14 10 16 22 9 38 14 17 11 50 94 15 12 32 40 24 31 56 25 51 KDIGO48 47 41 40 38 27 27 21 21 0 CH CA JP BE UK ANZ GE US FR SP IT SW * Data are from the initial prevalent cross-section of patients in each country; ‘Other combination includes all mono- or combination therapies not otherwise listed Serum Phosphorus of PD Patients in SYSU 8.31% N=2456 19.87% P (Mean) = 5.64± 1.95 mg/dl <3.5 19.63% 3.5-4.5 72.07% > 4.5 mg/dl 4.6-5.5 59.16% > 5.0 mg/dl 5.6-7.0 27.36% >7 47.23% > 5.5mg/dL KDIGO24.84% P（mg/dL) <3.5 3.5-4.5 4.6-5.5 5.6-7.0 >7.0 Patient No. 204 482 610 672 488 （%） 8.31 19.63 24.84 27.36 19.87 Target Achievements of Serum Phosphorus in PD Patients KDIGO Serum Calcium of PD Patients in SYSU 4.13% 7.91% 41.41% <8.4 N=2567 8.4-9.5 Ca (Mean) = 8.43± 1.82 mg/dl 9.6-10.2 >10.2 KDIGO46.55% Ca（mg/dL) <8.4 8.4-9.5 9.6-10.2 >10.2 Patient No. 1063 1195 203 106 （%） 41.41 46.55 7.91 4.13 Target Achievements of Serum Calcium in PD Patients KDIGO Serum PTH of PD Patients in SYSU 18.31% 21.42% <150 N=2026 150-299 Median PTH 329 14.76% 300-449 450-599 (172,520) 24.58% >600 KDIGO20.93% PTH (pg/ml) <150 150-299 300-449 450-599 >600 Patient No. 434 498 424 299 371 (%) 21.42 24.58 20.93 14.76 18.31 Target Achievements of iPTH in PD Patients KDIGO Risk Factors of Mortality in PD Patients Cross section analysis Risk factors Odds ratio 95% CI P-value Age (per 1 year older) 1.05 1.03-1.06 < 0.001 Davies score of Comorbidities (per 1 point greater) 1.24 1.01-1.52 0.05 Hemoglobin (per 1g/dL greater) 0.76 0.68-0.85 < 0.001 Serum albumin (per 1g/dL greater) 0.48 0.30-0.74 0.001 Serum creatinine (per 1mg/dL greater) 0.88 0.82-0.95 0.001 Serum phosphorus KDIGO1.27 1.06-1.51 0.01 (per 1mg/dL increasing) Serum uric acid (per 1mg/dL greater) 1.16 1.06-1.27 0.001 Use of ACEI/ARB (yes/no) 0.66 0.47-0.94 0.021 Data from Sun Yat-sen University PD registration database Effects of Ca, P, and Ca×P Effects on of the Ca, prognosis P, and Ca×P of on patients outcomes of PD patients KDIGO Baseline Characteristics of Serum Calcium, Phosphorus, Ca*P and iPTH of PD Patients Median Mean ± SD (interquartile range) Ca( mg/dl) 8.73 ± 1.01 8.74 (8.18-9.30) P(mg/dl) 5.18 ± 1.75 4.86 (4.03-6.04) Ca*P KDIGO44.7 ± 14.6 42.8(35.4-51.2) iPTH(pg/ml) 351 ± 301 284 (140-471) Note: Calcium concentration means corrected serum calcium concentration Correlation of Ca, P, Ca×P and iPTH at baseline in PD Patients Residual Active Calcium Phosphate Ca P Ca*P iPTH Urinal Albumin VD3 Agents binder Volume P -0.305a Ca×P 0.018 0.930a iPTH -0.414a 0.288a 0.157a Residual Urinal b a Volume -0.068 0.010 -0.012 0.096 Albumin 0.395a -0.055 0.072b 0.006 0.113a Active VD3 0.027 -0.098a KDIGO-0.103 0.213a 0.081a 0.135a Calcium Agents -0.032 0.021 0.010 0.119a 0.044 0.039 0.319a Phosphate binder -0.013 0.037 0.031 0.113a 0.040 0.060b 0.316a 0.950a Low calcium 0.143a -0.067b -0.016 0.002 -0.017 0.142a 0.244a 0.151a 0.196a dialysate a Correlation is significant at the 0.01 level (2-tailed).
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