Endocrine Abstracts

Introduction: Diabetic kidney disease (DKD) is a common cause of chronic kidney disease (CKD). In CKD bone mineralisation disorder (CKD-MBD), imbalanced feedback between phosphate, calcium, vitamin D, and parathyroid hormone (PTH) causes bone mineralisation loss, architecture damage and increased fracture risk. Treatment involves pharmacological interventions and dietary modification. Kidney Disease Improving Global Outcomes (KDIGO) have published guidance to aid management.

Aims: This project aimed to audit the quality of CKD-MBD management in a tertiary centre DKD clinic compared to the KDIGO CKD-MBD guideline.

Methods: 119 patients attending DKD clinic between September and November 2023 were retrospectively reviewed. Patients with an eGFR >60 ml/min/1.73m² were excluded. Data collected included demographics, biochemistry, renal replacement therapy status, pharmacological treatment, dietetic advice, bone mineral density (BMD) measurements and fractures.

Results and Discussion: Most patients received appropriate biochemical monitoring, but calcium was more intensively monitored compared to phosphate and PTH. Only 29% of patients had received a prior radiological BMD measurement. Treatment findings relevant to clinical practice included 63% of patients with hyperphosphatemia receiving dietician delivered low-phosphate dietary advice. Also, 36% of CKD G5d patients treated with vitamin D analogues for secondary hyperparathyroidism (SPTH) had a most recent PTH measurement outside the recommended target range of 2-9 multiples the upper limit of normal. 10% of patients had a recorded fracture, these occurred more frequently in lower eGFR patients not on dialysis. 6% of CKD stage G3a-G3b patients, who may be suitable for bisphosphonates, were prescribed the treatment. No patients were treated with Denosumab.

Conclusion: Clinicians working with DKD patients should be aware of the KDIGO guidance for CKD-MBD, particularly around dietary recommendations and treatment targets in SPTH patients. Improving BMD measurement frequency in suitable patients may help identify patients that would benefit from pharmacological intervention; few patients in this audit were benefiting from these treatments.