CHAPTER 9 Chronic Kidney Disease – Mineral and Bone Disorder

CHAPTER 9 Chronic Kidney Disease – Mineral and Bone Disorder
Fan Kin Sing Rozina Ghazalli Ching Chen Hua Liew Yew Fong Source: 20th MDTR Report 2012, NRR

Table 9.1.1: Phosphate Binder in HD patients, 1997-2012
Year Number of patients Calcium Carbonate Aluminium Hydroxide Lanthanum Sevelamer HcI n % 1997 1695 1543 91 417 25 1998 2141 1956 343 16 1999 2996 2693 90 244 8 2000 4390 3975 239 5 2001 5194 4810 93 145 3 2002 6108 5536 171 2003 7018 6425 92 118 2 2004 8155 7408 106 1 2005 9349 8568 98 2006 11682 10776 71 15 2007 12907 11868 57 37 2008 15388 14130 72 86 2009 17968 16445 34 247 2010 19509 17805 27 377 6 2011 22778 20886 35 514 88 2012 25800 23750 13 638 102 Source: 20th MDTR Report 2012, NRR

Table 9.1.2: Phosphate Binder in PD patients, 1997-2012
Year Number of patients Calcium Carbonate Aluminium Hydroxide Lanthanum Sevelamer HcI n % 1997 476 393 83 57 12 1998 541 425 79 46 9 1999 610 450 74 36 6 2000 662 522 15 2 2001 781 588 75 5 1 2002 891 713 80 2003 1543 1306 85 2004 1842 1552 84 24 2005 2207 1862 21 2006 2787 2373 14 2007 3577 3142 88 8 22 2008 4044 3495 86 42 2009 3482 2945 78 2010 3844 3391 4 93 2011 5087 4376 176 3 2012 5858 4952 202 62 Source: 20th MDTR Report 2012, NRR

Table 9.1.3: Phosphate Binders by Sector in HD patients

Table 9.2.1: Distribution of corrected serum calcium, HD patients, 1997-2012
Year Number of patients Mean SD Median LQ UQ % patients ≥2.1 & ≤2.37 mmol/L 1997 1633 2.3 0.3 2.2 2.5 40 1998 2060 44 1999 2732 39 2000 3701 2.4 42 2001 4618 0.2 2002 5485 43 2003 6466 46 2004 7536 47 2005 8630 49 2006 10881 2.1 50 2007 12275 52 2008 14478 53 2009 16850 2010 18655 2011 21733 2012 24679 54 Source: 20th MDTR Report 2012, NRR

Figure 9.2.1: Cumulative distribution of corrected serum calcium, HD patients, 1997-2012
Source: 20th MDTR Report 2012, NRR

Table 9.2.2: Distribution of corrected serum calcium, PD patients, 1997-2012
Year Number of patients Mean SD Median LQ UQ %patients ≥2.1 & ≤2.37mmol/L 1997 469 2.5 0.3 2.3 2.6 25 1998 535 2.4 30 1999 593 0.2 2000 635 2001 744 2.7 22 2002 859 24 2003 1167 27 2004 1276 23 2005 1338 2006 1495 38 2007 1748 2.2 42 2008 2017 2009 2135 39 2010 2301 37 2011 2506 2012 2848 Source: 20th MDTR Report 2012, NRR

Figure 9.2.2: Cumulative distribution of corrected serum calcium, PD patients, 1997-2012

Table 9.2.3: Distribution of serum phosphate, HD patients, 1997-2012
Year Number of patients mean SD Median LQ UQ Percent patients with serum phosphate (mmol/L) <0.8 ≥0.8 &<1.3 ≥1.3 &<1.8 ≥1.8 &<2.2 >2.2 1997 1649 1.9 0.5 1.6 2.3 1 10 33 27 29 1998 2051 2.2 9 31 1999 2861 1.5 12 32 28 2000 4078 0.6 1.8 34 24 2001 4765 13 35 2002 5679 26 2003 6588 2 36 2004 7620 14 37 25 23 2005 8834 1.7 1.4 2.1 16 38 19 2006 11129 17 39 18 2007 12424 40 2008 14874 41 2009 17246 15 2010 18880 2011 22164 2012 25134 Source: 20th MDTR Report 2012, NRR

Figure 9.2.3: Cumulative distribution of serum phosphate, HD patients, 1997-2012

Table 9.2.4: Distribution of serum phosphate, PD patients, 1997-2012
Year Number of patients mean SD Median LQ UQ Percent patients with serum phosphate (mmol/L) <0.8 ≥0.8 &<1.3 ≥1.3 &<1.8 ≥1.8 &<2.2 >2.2 1997 470 1.6 0.4 1.5 1.3 1.8 1 28 44 20 8 1998 537 0.5 1.9 23 12 1999 583 2 21 45 22 10 2000 633 4 26 43 19 2001 732 1.2 3 32 40 17 7 2002 862 30 42 16 9 2003 1173 29 2004 1278 27 39 11 2005 1343 2006 1511 24 2007 1757 18 13 2008 2022 2009 2147 41 2010 2303 2011 2535 2012 2859 Source: 20th MDTR Report 2012, NRR

Figure 9.2.4: Cumulative distribution of serum phosphate, PD patients, 1997-2012

Percent patients with calcium phosphate product (mmol2/L2)
Table 9.2.5: Distribution of corrected calcium x phosphate product, HD patients Year Number of patients Mean SD Median LQ UQ Percent patients with calcium phosphate product (mmol2/L2) <3.5 3.5 & <4.5 4.5 & <5.5 5.5 1997 1615 4.5 1.3 3.6 5.3 23 28 29 20 1998 2020 1.2 4.4 3.7 5.2 21 32 19 1999 2698 4.3 3.4 27 26 18 2000 3648 3.5 25 31 2001 4555 4.2 24 2002 5403 2003 6383 4.1 3.3 5.1 30 16 2004 7414 5 22 15 2005 8496 4 3.9 3.2 4.8 36 12 2006 10758 3.8 3.1 4.7 38 11 2007 12172 4.6 33 10 2008 14360 39 9 2009 16713 34 2010 18535 2011 21580 2012 24461 1.1 37 Source: 20th MDTR Report 2012, NRR

Figure 9.2.5: Cumulative distribution of corrected calcium x phosphate product, HD patients Source: 20th MDTR Report 2012, NRR

Percent patients with calcium phosphate product (mmol2/L2)
Table 9.2.6: Distribution of corrected calcium x phosphate product, PD patients Year Number of patients mean SD Median LQ UQ Percent patients with calcium phosphate product (mmol2/L2) <3.5 3.5 & <4.5 4.5 & <5.5 5.5 1997 468 3.9 1.1 3.7 3.1 4.5 40 35 17 7 1998 533 4 3.8 3.2 4.6 38 16 11 1999 580 1.2 4.8 36 33 22 10 2000 621 44 31 8 2001 723 3.6 2.9 46 30 18 2002 856 45 29 2003 1162 3 43 2004 1274 4.7 41 12 2005 1333 1.3 2006 1494 9 2007 1745 15 2008 2009 47 28 2130 2010 2289 2011 2499 2012 2839 4.4 Source: 20th MDTR Report 2012, NRR

Figure 9.2.6: Cumulative distribution of corrected calcium x phosphate product, PD patients Source: 20th MDTR Report 2012, NRR

Table 9.2.7(a): Variation in corrected median serum calcium level among HD centres 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 2.1 2.3 2.4 2.5 1998 49 2 1999 66 1.9 2.6 2000 90 3.2 2001 115 2002 138 2.2 2003 169 2004 205 2005 232 1.8 2006 277 2007 313 2008 364 2009 406 1.5 2010 439 2011 505 1.6 2012 552 Source: 20th MDTR Report 2012, NRR

Figure 9.2.7(a): Variation in median serum calcium among HD patients, HD centres, 2012

Table 9.2.8(a): Variation in corrected median serum calcium level among PD centres 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 2.1 2.4 2.5 2.6 1998 9 2.3 1999 10 2000 11 2001 12 2002 15 2003 18 2.2 2004 2005 19 2006 22 2007 2008 24 2009 25 2010 26 2011 28 2012 Source: 20th MDTR Report 2012, NRR

Figure 9.2.8(a): Variation in median serum calcium level among PD patients, PD centres, 2012

Table 9. 2. 7(b): Proportion of patients with serum calcium 2. 1 to 2
Table 9.2.7(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 6 16 31 40 47 66 80 1998 49 12 21 38 43 50 71 78 1999 11 24 39 48 58 2000 90 30 64 98 2001 115 8 65 87 2002 138 5 17 33 53 69 82 2003 169 35 56 70 91 2004 205 22 72 83 2005 232 39.5 57 2006 277 13 42 59 2007 313 9 29 44 52 61 93 2008 364 46.5 54 60 73 2009 406 86 2010 439 32 62 2011 505 46 55 63 74 2012 552 63.5 75 100 Source: 20th MDTR Report 2012, NRR

Figure 9.2.7(b): Variation in proportion of patients with serum calcium 2.1 to 2.37 mmol/L, HD centres, 2012 Source: 20th MDTR Report 2012, NRR

Table 9. 2. 8(b): Proportion of patients with serum calcium 2. 1 to 2
Table 9.2.8(b): Proportion of patients with serum calcium 2.1 to 2.37 mmol/L, PD centres Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 10 18 26 29 53 1998 9 13 23 38 40 60 1999 5 22 28.5 31 42 2000 11 14 24 33 46 2001 12 17 35.5 2002 15 20 25 34 41 2003 19 32 39 58 2004 24.5 2005 35 43 51 2006 16 44.5 49 76 2007 45.5 50 62 63 2008 31.5 65 2009 52 2010 27 34.5 57 2011 28 37.5 2012 42.5 71 Source: 20th MDTR Report 2012, NRR

Figure 9.2.8(b): Variation in proportion of patients with serum calcium 2.1 to 2.37 mmol/L, PD centres, 2012 Source: 20th MDTR Report 2012, NRR

Table 9.2.9(a): Variation in median serum phosphate level among HD centres, 2002- 2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 1.3 1.5 1.7 1.9 2 2.3 2.8 1998 49 1.8 2.2 2.6 1999 68 1.1 1.6 2.1 2.5 2000 101 1.4 3.7 2001 118 2.4 2002 145 2003 175 0.9 2004 210 2005 233 0.8 2006 283 1 2007 314 2008 370 2009 411 2010 446 2011 507 2012 560 Source: 20th MDTR Report 2012, NRR

Figure 9.2.9(a): Variation in median serum phosphate level among HD patients, HD centres, 2012

Table 9.2.10(a): Variation in median serum phosphate levels among PD centres 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 1.4 1.5 1.6 1.7 1998 9 1.8 1999 2000 11 1.3 2001 12 1.9 2002 15 2.1 2003 18 2004 2005 19 2006 22 2007 2008 24 1.2 2009 25 2.2 2010 26 2011 28 2012 Source: 20th MDTR Report 2012, NRR

Figure 9.2.10(a): Variation in median serum phosphate level among PD patients, PD centres 2012

Table 9. 2. 9(b): Proportion of patients with serum phosphate 1. 13-1
Table 9.2.9(b): Proportion of patients with serum phosphate mmol/L, HD centres, Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 7 18 29 39 59 68 1998 49 8 20 30 35 44 63 70 1999 14 25.5 34.5 60 65 2000 101 17 36 57 73 2001 118 21 32 38.5 47 62 67 2002 145 10 37 46 66 90 2003 175 9 19 31 40 48 64 92 2004 210 50 2005 233 12 25 53 71 2006 283 38 54 87 2007 314 27 2008 370 28 56 2009 411 80 2010 446 4 24 77 2011 507 94 2012 560 6 55 Source: 20th MDTR Report 2012, NRR

Figure 9.2.9(b): Variation in proportion of patients with serum phosphate mmol/L, HD centres, 2012 Source: 20th MDTR Report 2012, NRR

Table 9. 2. 10(b): Proportion of patients with serum phosphate 1. 13-1
Table (b): Proportion of patients with serum phosphate mmol/L, PD centres Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 53 54 58 66 76 1998 9 43 60 61 80 1999 51 68 2000 11 41 50 64 2001 12 48.5 77 2002 15 47 83 2003 18 44 2004 39 49 52 2005 19 38 46 2006 22 48 2007 40 56 73 78 2008 24 30 47.5 52.5 59 65 71 2009 25 20 62 2010 26 34 45 50.5 67 2011 28 46.5 51.5 58.5 75 81 2012 33 63 Source: 20th MDTR Report 2012, NRR

Figure (b): Variation in proportion of patients with serum phosphate mmol/L, PD centres 2012 Source: 20th MDTR Report 2012, NRR

Table 9. 2. 9(c): Proportion of patients with serum phosphate 0. 8-1
Table 9.2.9(c): Proportion of patients with serum phosphate mmol/L, HD centres, 2012 Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 5 9 14 28 50 1998 49 8 10 22 38 1999 68 42 54 2000 101 7 11 17 26 37 2001 118 2 11.5 18 27 53 2002 145 6 12 60 2003 175 31 2004 210 12.5 19 29 46 2005 233 15 20 32 52 2006 283 3 33 2007 314 16 21 47 2008 370 35 2009 411 2010 446 2011 507 30 83 2012 560 8.5 43 Source: 20th MDTR Report 2012, NRR

Figure 9.2.9(c): Variation in proportion of patients with serum phosphate mmol/L, HD centres, 2012 Source: 20th MDTR Report 2012, NRR

Table 9. 2. 10(c): Proportion of patients with serum phosphate 0. 8-1
Table (c): Proportion of patients with serum phosphate mmol/L, PD centres, 2012 Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 12 18 27 34 35 1998 9 16 20 29 31 1999 6 14 22 26 2000 11 4 24 33 36 2001 14.5 32 38 43 2002 15 30 50 2003 23 28.5 42 2004 8 19 25.5 48 2005 25 45 2006 54 2007 5 20.5 2008 17 30.5 47 73 2009 10 2010 24.5 46 2011 28 44 2012 3 15.5 21.5 31.5 Source: 20th MDTR Report 2012, NRR

Figure (c): Variation in proportion of patients with serum phosphate mmol/L, PD centres 2012 Source: 20th MDTR Report 2012, NRR

Table 9.2.11(a): Variation in corrected median calcium x phosphate product HD centres 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 2.9 3.6 4.1 4.3 4.8 5.3 6.2 1998 49 3.2 3.4 4.5 4.7 5.2 5.4 1999 65 2.3 4 5.6 2000 89 3.1 3.5 4.6 5.1 2001 113 3.9 4.2 6 2002 138 2003 169 2.2 3.3 4.9 5.5 2004 204 3.8 4.4 2005 225 2.1 2006 275 5 2007 310 2.5 2008 361 2.7 5.7 2009 399 2.6 5.9 2010 438 3.7 6.3 2011 503 2 2012 549 Source: 20th MDTR Report 2012, NRR

Figure (a): Variation in median corrected calcium x phosphate product among HD patients, HD centres, 2012 Source: 20th MDTR Report 2012, NRR

Table 9.2.12(a): Variation in corrected median calcium x phosphate product PD centres 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 3.5 3.6 3.7 3.8 3.9 1998 9 4 1999 4.1 4.3 2000 11 3.4 2001 12 3.1 2002 15 3.3 4.9 2003 18 3.2 2004 4.4 2005 19 2006 22 3 4.2 2007 2008 24 2.8 4.7 5.1 2009 25 4.5 4.8 2010 26 4.6 2011 28 2012 Source: 20th MDTR Report 2012, NRR

Figure (a): Variation in median corrected calcium x phosphate product among PD centres, to 2012 Source: 20th MDTR Report 2012, NRR

Table (b): Proportion of patients with corrected calcium x phosphate < 4.5 mmol2/L2, HD centres Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 45 15 25 38 54 65 79 100 1998 49 18 30 41 52 66 82 91 1999 20 27 44 55 2000 89 12 58 78 88 2001 113 19 37 47 57 70 81 2002 138 33 48 56 67 90 2003 169 50 61 71 83 2004 204 53 63 2005 225 24 69 77 2006 275 46 62 2007 310 32 73 92 2008 361 64 72 2009 399 95 2010 438 8 43 60 76 2011 503 23 2012 549 29 80 Source: 20th MDTR Report 2012, NRR

Figure (b): Variation in proportion of patients with corrected calcium x phosphate product < 4.5 mmol2/L2, HD centres 2012 Source: 20th MDTR Report 2012, NRR

Table 9.2.12(b): Proportion of patients with corrected calcium x phosphate < 4.5 mmol2/L2, PD
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 7 70 74 78 82 94 1998 9 66 71 73 79 90 1999 57 65 72 77 80 2000 11 62 81 85 2001 12 50 71.5 75 81.5 84 2002 15 43 88 2003 18 61 74.5 2004 56 72.5 89 2005 19 55 2006 22 67 70.5 96 2007 52 64 98 2008 24 40 41 91 97 2009 25 49 68 76 86 2010 26 48 69 2011 28 63.5 95 2012 47 66.5 83.5 Source: 20th MDTR Report 2012, NRR

Figure (b): Variation in proportion of patients with corrected calcium x phosphate product < 4.5 mmol2/L2, PD centres, 2012 Source: 20th MDTR Report 2012, NRR

Had Parathyroidectomy
Table 9.3.1(a): Treatment of hyperparathyroidism in HD patients, Year Number of patients On calcitriol On Paricalcitol Had Parathyroidectomy n % 1997 1695 694 41 1998 2141 652 30 1999 2996 770 26 2000 4390 1082 25 2001 5194 1145 22 2002 6108 1375 23 2003 7018 1690 24 2004 8155 2029 2005 9349 2556 27 43 2006 11682 3823 33 34 152 1 2007 12907 4950 38 58 181 2008 15388 6337 173 2009 17968 7784 82 167 2010 19509 9078 47 154 170 2011 22778 11042 48 132 178 2012 25800 11972 46 258 269 Source: 20th MDTR Report 2012, NRR

Had Parathyroidectomy
Table 9.3.1(b): Treatment of hyperparathyroidism in PD patients, Year Number of patients On Calcitriol On Paricalcitol Had Parathyroidectomy n % 1997 476 114 24 1998 541 110 20 1999 610 75 12 2000 662 96 15 2001 781 84 11 2002 891 130 2003 1543 311 2004 1842 439 2005 2207 534 8 2006 2787 658 6 27 1 2007 3577 1033 29 9 22 2008 4044 1210 30 26 2009 3482 1232 35 5 16 2010 3844 1531 40 4 2011 5087 1901 37 25 2012 5858 2222 38 62 48 Source: 20th MDTR Report 2012, NRR

Table 9.3.2(a): Distribution of iPTH, HD patients, 1997-2012
Year Number of Patients Mean SD Median LQ UQ Percent patients with iPTH (pg/ml) <150 150 & 300 >300 & 500 >500 1997 1088 195.1 282.9 76.8 26 240.3 66 13 9 11 1998 938 126.1 202 44 15 141 76 12 6 1999 1533 185.6 260.7 78.9 23.5 240 64 16 10 2000 2242 149.2 230 57.8 17.6 177 72 8 7 2001 2760 141.2 219.5 57 18 164.8 73 2002 3391 161.6 248 19 191 70 14 2003 4068 219.1 328.8 79 24.3 263.3 2004 4748 212.1 325.6 74.3 22.6 257.3 65 2005 5826 221.6 312.5 83.8 26.5 297 61 2006 7744 307.2 88 29 292 2007 9151 245.8 332.7 105 30.4 335.5 58 2008 10753 260.8 330.9 127 36 361 54 17 2009 12642 269.4 337.3 140.1 40 367.1 52 2010 14364 235.6 319.3 98.5 30.5 319.8 2011 16716 222.9 86.8 29.2 302.4 2012 19189 290.3 339.8 165.6 46.5 408.6 48 Source: 20th MDTR Report 2012, NRR

Figure 9.3.2(a): Cumulative distribution of iPTH, HD, 1997-2012

Table 9.3.2(b): Distribution of iPTH, diabetic HD patients, 1997-2012
Year Number of Patients Mean SD Median LQ UQ Percent patients with iPTH (pg/ml) <150 150 & 300 >300 & 500 >500 1997 197 129 218 50 17.5 125.5 78 11 7 5 1998 178 84.5 139.4 24.4 90 83 9 6 2 1999 329 122.4 182.8 54.5 16 148 75 14 2000 518 82 123.7 34.8 10 95.5 84 1 2001 704 80.6 136 31.2 10.9 87.3 4 2002 938 90.9 157.4 34.9 97 3 2003 1204 120.1 209.3 40.2 13.3 120.3 79 2004 1532 111.4 193.6 38 114.4 80 2005 2107 149.5 246.1 47.4 16.1 170.5 72 12 8 2006 3069 155 253.2 54 20.8 173.5 2007 3681 183.1 267.4 70.7 23 235.5 66 2008 4594 208.9 275.3 99 29.1 286.5 59 17 2009 5641 218.3 284.1 111.1 33.7 292 57 18 2010 6571 189.7 269 26 256 64 15 2011 7543 182.4 263.7 66.9 24.6 241.4 13 2012 8737 250.2 290.7 146 42.4 359 51 19 Source: 20th MDTR Report 2012, NRR

Figure 9.3.2(b): Cumulative distribution of iPTH, diabetic HD patients, 1997-2012

Percent patients with iPTH (pg.ml)
Table 9.3.2(c): Distribution of iPTH, non-diabetic HD patients, Year Number of Patients Mean SD Median LQ UQ Percent patients with iPTH (pg.ml) <150 150 & 300 >300 & 500 >500 1997 891 209.7 293.4 83.5 28.5 272 63 14 10 13 1998 760 135.9 212.9 49 17 153 74 12 7 1999 1204 202.9 275.8 92.2 26 267 61 11 2000 1724 169.4 250 65.9 21.8 204.3 68 8 9 2001 2056 162 238.1 71 23.4 198 69 16 2002 2453 188.7 270.1 84 235 65 15 2003 2864 260.7 359.6 108 33.5 330.5 57 2004 3216 260.1 362.7 102.3 30.5 338.8 58 2005 3719 262.5 337.8 114.1 35.5 364.5 55 2006 4675 261.2 331.4 122.8 39 362.5 54 2007 5470 288 364.2 135.1 38.7 403 52 19 2008 6159 299.5 362.2 155 42.6 418 21 2009 7001 310.6 369.6 170.5 47.8 433.5 47 2010 7793 274.4 351.6 126.7 36.5 386 2011 8868 258.1 344.8 108.1 34.7 357.6 56 2012 10086 328 374.2 190 51.5 469.1 45 23 Source: 20th MDTR Report 2012, NRR

Figure 9.3.2(c): Cumulative distribution of iPTH, non-diabetic HD patients, 1997-2012

Table 9.3.3(a): Distribution of iPTH, PD patients, 1997-2012
Year Number of Patients Mean SD Median LQ UQ Percent patients with iPTH (pg/ml) <150 150 & 300 >300 & 500 >500 1997 293 112.3 151 58 25 137 78 12 7 3 1998 280 93.7 117.4 47.5 18.5 126 81 13 5 1 1999 365 132.8 176.4 61.5 21 179.3 71 15 10 4 2000 406 109.8 192.4 46.8 15.5 118 80 2001 531 108 155.8 51.5 13.5 137.6 76 6 2002 681 160.6 219.1 82 26 196 67 17 8 2003 938 230.3 340.3 95 37.4 260 61 18 9 2004 1115 216.4 302.9 105 39.5 60 19 11 2005 1071 247.1 306.4 125.3 39 352 54 2006 1265 224.6 271.9 128 41.5 318 20 14 2007 1436 248.4 297.1 152.5 51 332.8 50 22 2008 1608 264.2 295.3 170.3 57.3 357.7 46 2009 1824 270.6 292.7 174.2 67.8 381 45 16 2010 1905 261.5 294.8 163 371 48 2011 2093 283.7 157.5 48.7 342 2012 2317 278.6 298.8 189.5 64 389.6 43 Source: 20th MDTR Report 2012, NRR

Figure 9.3.3(a): Cumulative distribution of iPTH, PD patients, 1997-2012

Table 9.3.3(b): Distribution of iPTH, diabetic PD patients, 1997-2012
Year Number of Patients Mean SD Median LQ UQ Percent patients with iPTH (pg/ml) <150 150 & 300 >300 & 500 >500 1997 90 61.3 66.1 39 15 90.5 91 7 2 1998 84 59.2 68.4 34.3 10.3 88.5 1999 99 92.9 143 41 17 111 82 11 4 3 2000 48.7 60.8 27.4 6 63 9 1 2001 159 63.6 87.1 31 6.8 79 88 2002 194 98.5 158.3 52.8 125.8 12 2003 312 122.6 179.7 65.6 29 146.8 75 2004 358 127 187.1 63.3 24.1 145 5 2005 348 161.4 241.4 67 22.5 192.3 70 8 2006 434 149.5 198.4 88.9 32.5 186.5 68 19 2007 544 176.4 204.6 113 41.8 237.8 58 25 2008 692 211.3 228.4 141.2 56.3 293.8 51 24 2009 750 186.8 184.9 132 57.5 255.5 54 26 13 2010 661 197.4 216.8 131 42 295 21 16 2011 653 189.2 208.2 128 44 272.5 2012 678 200.5 214.8 131.3 56 282.5 52 Source: 20th MDTR Report 2012, NRR

Figure 9.3.3(b): Cumulative distribution of iPTH, diabetic PD patients, 1997-2012

Percent patients with iPTH (pg/ml)
Table 9.3.3(c): Distribution of iPTH, non diabetic PD patients, Year Number of Patients Mean SD Median LQ UQ Percent patients with iPTH (pg/ml) <150 150 & 300 >300 & 500 >500 1997 203 134.9 171.3 68 29.5 167 72 14 9 4 1998 196 108.5 130.3 57.5 22.3 139.3 77 16 6 2 1999 266 147.7 185.4 75.3 22.5 67 12 5 2000 295 132.7 218.4 141.5 76 13 2001 372 127 173.9 67.5 17.2 18 7 2002 487 185.3 234.7 100 33 241 62 19 10 2003 626 284 385.8 130.8 49.9 321.5 54 17 2004 757 258.6 336.3 138 50 325 53 20 2005 723 288.3 325.3 172 48.8 413.5 47 15 2006 831 263.8 295.9 164 386 21 2007 892 292.3 334 191 404.8 44 2008 916 304.1 331.7 208.4 422.5 41 2009 1074 329.1 336.7 224.6 80 461 39 22 2010 1244 295.6 323.8 186.3 56.6 423.7 45 2011 1387 277.6 307.7 182.7 55.6 387.5 2012 1586 306 314.8 220.7 69.5 434 40 Source: 20th MDTR Report 2012, NRR

Figure 9.3.3(c): Cumulative distribution of iPTH, non diabetic PD patients, 1997-2012

Table 9.3.4(a): Variation in iPTH among HD centres 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 36 8 23.3 47.5 70 104.9 198 580 1998 30 13.2 24.2 43.5 105 144 295.5 1999 42 10 17 38.6 76 145.2 250 443.5 2000 57 5.6 15.4 31.5 48.5 86 347 487.5 2001 72 7.2 10.4 26.7 56 91 225.8 536 2002 92 1.6 10.8 27.2 44.5 138.5 304.5 347.8 2003 112 4.2 34.8 82 175.2 375.2 460 2004 136 3.6 12 28.8 72.9 205.4 370.5 627 2005 166 6.1 14.3 37.2 95.3 206.8 409.5 626.4 2006 221 5.9 15.9 41.5 92.9 377.5 643.8 2007 243 12.4 19 46.3 106.5 240 411.1 643 2008 292 8.8 22.4 59.1 141.3 415 712.5 2009 336 2.6 27 66.4 156.6 245.2 403.6 825.2 2010 364 5.5 18.6 41.9 104.1 235.4 384.8 609.3 2011 431 3.3 19.9 42.1 92.4 228.5 422.5 1217.5 2012 493 11.4 32.8 71.7 186.1 287.8 459 769.8 Source: 20th MDTR Report 2012, NRR

Figure 9.3.4(a): Variation in median iPTH among HD patients, HD centres 2012

Table 9.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 36 8 11 18 29 1998 30 4 8.5 17 31 1999 42 9 15 24 33 2000 57 5 10 2001 72 20.5 40 2002 92 2.5 20 32 45 2003 112 6 14 2004 136 19 50 2005 166 7 13 47 2006 221 2007 243 21 52 2008 292 16 23 43 2009 336 63 2010 364 22 2011 431 58 2012 493 3 53 Source: 20th MDTR Report 2012, NRR

Figure 9.3.4(b): Variation in proportion of patients with iPTH 150-300pg/ml, HD centres, 2012

Table 9.3.5(a): Variation in median iPTH among PD patients 1997-2012
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 5 36.5 44.8 47 81 120 1998 16 57.5 59.5 66.3 74 1999 8 16.5 49.9 75.2 87.5 200.9 2000 9 33 46.5 63.5 122 2001 11 15.4 42.5 91 274 2002 14 27.3 50 82.9 107 280.5 2003 17 22.4 70 135 175 309.5 2004 18 41 74.5 138.8 169.3 329.6 2005 25.5 85 140.6 259.5 493.3 2006 20 35.3 36.1 88 158 233.3 354.8 367 2007 22 26.3 32 107.5 202.1 283.5 440 513.9 2008 35 120.3 186.2 310.9 352.3 454.5 2009 23 40 51 129.1 195 317.9 468.8 1171 2010 24 29.4 33.6 96.8 217.9 287.4 517.3 688.6 2011 25 25.9 27 91.7 194.7 291.5 362 419 2012 35.2 46 138.6 259.3 331 478.5 530 Source: 20th MDTR Report 2012, NRR

Figure 9.3.5(a): Variation in median iPTH among PD patients, PD centres, 2012

Table 9.3.5(b): Proportion of patients with iPTH 150-300pg/ml
Year Number of centres Min 5th Centile LQ Median UQ 95th Centile Max 1997 5 7 10 13 15 27 1998 9 17 1999 8 6 12 21.5 26 2000 18 2001 11 14 19 30 2002 15.5 21 24 2003 2 22 33 2004 20 25 29 2005 23 2006 5.5 20.5 26.5 36.5 40 2007 3 31 39 2008 2009 28 2010 4 32 43 2011 2012 1 16 Source: 20th MDTR Report 2012, NRR

Figure 9.3.5(b): Variation in proportion of patients with iPTH 150-300pg/ml, PD centres 2012

iPTH (pg/ml) & ALP (u/l) groups
Table 9.4.1: Low turnover bone disease vs high turnover bone disease in dialysis patient, Year Number of Patients iPTH (pg/ml) & ALP (u/l) groups iPTH<150 & ALP <120 iPTH >300 & 600 & ALP >150 iPTH >600 & ALP >150 HD PD n % 1997 1381 36 14 8 1 4 1998 1218 41 15 5 2 1999 1898 35 10 2000 2648 40 9 7 2001 3291 42 6 3 2002 4072 2003 5006 38 2004 5863 2005 6897 2006 9009 2007 10587 37 2008 12361 2009 14466 34 2010 16269 2011 18809 2012 21506 30 Source: 20th MDTR Report 2012, NRR

Table 9.4.2: Low turnover bone disease vs high turnover bone disease by gender, 1997-2012
Year Number of Patients iPTH<150 pg/ml & ALP <120u/l iPTH>300 & 600 pg/ml & ALP >150 u/l iPTH>600 pg/ml & ALP >150u/l Male Female n % 1997 1381 29 20 4 2 3 1998 1218 33 24 1 1999 1898 25 19 5 2000 2648 27 21 2001 3291 28 23 2002 4072 2003 5006 22 2004 5863 2005 6897 26 2006 9009 2007 10587 2008 12361 18 2009 14466 17 2010 16269 2011 18451 2012 21087 15 Source: 20th MDTR Report 2012, NRR

Table 9.4.3: Low turnover bone disease vs high turnover bone disease by age group, 1997-2012
Year Number of Patients iPTH<150 pg/ml & ALP <120u/l iPTH>300 & 600 pg/ml & ALP >150u/l iPTH>600 pg/ml >60years <=60years n % 1997 1381 6 43 4 1998 1218 50 2 1999 1898 5 39 7 2000 2648 42 2001 3291 9 3 2002 4072 10 41 2003 5006 36 2004 5863 11 2005 6897 35 1 2006 9009 12 33 2007 10587 30 2008 12361 28 2009 14466 27 2010 16269 2011 18451 2012 21087 23 Source: 20th MDTR Report 2012, NRR

Table 9.4.4: Low turnover bone disease vs high turnover bone disease by diabetes status, 1997-2012
Year Number of Patients iPTH<150 pg/ml & ALP <120 iPTH>300 & 600 pg/ml & ALP >150 iPTH>600 pg/ml Diabetic Non Diabetic n % 1997 1381 13 36 1 8 4 1998 1218 14 43 5 2 1999 1898 12 33 11 2000 2648 35 7 2001 3291 15 6 2002 4072 17 2003 5006 29 2004 5863 19 28 2005 6897 20 27 2006 9009 24 2007 10587 23 2008 12361 21 3 2009 14466 18 2010 16269 22 2011 18451 2012 21087 16 Source: 20th MDTR Report 2012, NRR

CHAPTER 9 Chronic Kidney Disease – Mineral and Bone Disorder

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CHAPTER 9 Chronic Kidney Disease – Mineral and Bone Disorder

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