Objective: To describe the frequency of prescription of phosphate binders (PB) and calcitriol for patients on chronic hemodialysis in Salvador, Brazil, and to assess whether treatment is in agreement with recommendations of the Kidney Disease Outcomes Quality Initiative (K/DOQI).
Methods: Cross section of baseline data of the PROHEMO study. The frequency of prescription of PB and calcitriol according to laboratory indicators of mineral metabolism was compared with K/DOQI recommendations.
Results: Sevelamer alone (i.e., not combined with other PB) was prescribed for 45.4% of patients, calcium carbonate (CaCO3) alone for 26.5%, sevelamer combined with CaCO3 for 2.1% and calcium acetate for 5.2%. Prescription of PB was noted in 53% of the patients with phosphorus <3.5 mg/dL and 40% with phosphorus <3.0 mg/dL. In disagreement with K/DOQI, prescription of calcitriol was found in 19% of patients with PTH<150 pg/mL and prescription was absent for approximately 35.4% with PTH>300 pg/dL combined with phosphorus equal or less than 5.5 mg/dL, calcium equal or less than 9.5 mg/dL and calcium x phosphorus product (CaxP)<55 mg2/dL2. For this latter group 38% had a prescription of sevelamer without other phosphate binders.
Conclusion: Results show a large percentage of prescriptions of sevelamer among patients on maintenance hemodialysis in a Brazilian city, despite the high cost of the medication and absence of contraindications for PB with calcium salts. Results in patients with PTH<150 pg/mL and with PTH>300 pg/mL combined with certain concentrations of calcium, phosphate and CaxP also indicate the need to evaluate practices for use of phosphate binders and calcitriol.