Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

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Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 169 - 172

Achieving the Urea Reduction Ratio (URR) as a Predictor of the Adequacy and the NKF-K/DOQI Target for Calcium, Phosphorus and Ca × P Product in ESRD Patients Who Undergo Haemodialysis

V. Sunanda, B. Santosh, D. Jusmita, B. Prabhakar Rao

1. Associate Professor in Biochemistry 2. Final year P.G. Student in M.D. Biochemistry 3. Associate Professor in Biochemistry 4. Professor in Biochemistry NAM E OF DEPARTM ENT (S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRI BUTED : Prathima Institute Of Medical Sciences, Nagunoor, Karimnagar, Andhra Pradesh, India.

Correspondence Address :
Sunanda Vusikala
Associate professor,
Department of Biochemistry,
Prathima institute of medical sciences,
Nagunoor, Karimnagar, Andhra Pradesh,India.
Phone: 09703777696


Introduction: Among patients with end-stage renal disease (ESRD) who are treated with haemodialysis (HD), the solute clearance during dialysis is a determinant of the mortality. Also, elevated serum calcium (Ca), phosphorus (P) or the Ca × P product is associated with cardiovascular calcification and mortality in these patients. Our study was aimed at assessing the targets to be achieved, which were laid down by the NKF-K/DOQI guidelines for the urea reduction ratio (URR), serum calcium (Ca), phosphorus (P) and the Ca × P product in ESRD patients who underwent haemodialysis.

Methods: We retrospectively analyzed the pre-dialysis and post-dialysis blood samples of 35 patients who were on chronic haemodialysis. For the adequacy of the dialysis, the urea reduction ratio (URR) was calculated by (predialysisurea – postdialysisurea) divided by predialysisurea and it was expressed in %. Calcium and phosphorus were measured from the fasting blood samples and the Ca × P product was calculated.

Results: The mean urea reduction rate (URR) was 66.4% (adequate URR is >65%). The Student’s t-test (paired) was done on the results of the pre-dialysis and post-dialysis serum urea, creatinine and the uric acid levels. There was a significant (p<0.001) reduction in these parameters, thus suggesting the adequacy of the dialysis. The levels of the mean serum calcium, phosphorus and the Ca × P product were 8.59 ± 0.78 mg/dL, 5.82 ± 0.98 mg/dL and 49.88 ± 8.42 mg2/dL2 respectively. There was no achievement of the target phosphorus levels but the target levels of calcium and the Ca × P product were achieved.

Conclusion: The NKF-K/DOQI target of the mean urea reduction rate (URR) was achieved, thus suggesting the adequacy of the dialysis. The NKF-K/DOQI target for mean phosphorus was not achieved, thus suggesting the inadequacy of the oral phosphate binders, poor compliance or no proper dietary phosphorus reduction.


Calcium × phosphate (Ca × P) product, End stage renal disease (ESRD), Haemodialysis (HD), Hyperphosphataemia, National Kidney Foundation – Kidney Disease Outcome Quality Initiative (NKF-K/DOQI), Phosphate binders, urea reduction ratio (URR)

Numerous outcome studies have demonstrated a correlation between the delivered dose of the haemodialysis and the patient mortality and morbidity (1),(2),(3),(4),(5),(6),(7). The evidence from them has demonstrated that the mortality among the ESRD patients was lower when sufficient haemodialysis treatments were provided. Because there is a poor correlation between the dialysis care team’s clinical assessment of the haemodialysis adequacy and the patients’ clinical outcomes, an unnecessary risk is placed on the patient, unless rigorous methods of evaluation are used. The clinical signs and symptoms alone are not the reliable indicators of the haemodialysis adequacy (8). Urea is a substance that is most often monitored in the clinical practice as a surrogate for the measurement of the clearance of small solutes in general. The reasons for this are that urea is a small, readily dialyzed solute that is the bulk catabolite of the dietary protein, that it constitutes 90% of the waste nitrogen that is accumulated in body water between the haemodialysis treatments, that it is easily measured in blood, and that the fractional clearance Original Articleof urea in body water correlates with the patient outcomes such as mortality and morbidity.

Of the three methods (Urea Kinetic Modelling, Kt/V and URR) that the NKF- K/DOQI considered as appropriate for measuring the delivered dose of haemodialysis, the URR is the simplest to execute, which is the parameter which is most commonly used to express the dialysis dose (9) and the resultant popularity of the URR (10). The URR has been shown to be a statistically significant predictor of mortality for the ESRD patients. It was recommended that Kt/V should be reported in terms of equilibrated Kt/V (eKt/V) (11) or single-pool Kt/V (spKt/V) (12). The K-DOQI guidelines recommend that the adequacy of the dialysis dose should be measured routinely, typically on a monthly basis, by using either spKt/Vurea or the Urea reduction ratio (URR). The minimum recommended target adequacy levels are either spKt/Vurea of 1.2 or URR of 65% per dialysis session, which is delivered 3 times a week (13).

NKF-K/DOQI recommends serum concentrations of corrected calcium in the range from 8.4 to 9.5 mg/dL and serum phosphorusconcentrations between 3.5 and 5.5 mg/dl. The serum Ca × P product concentration should be <55 mg2/dL2 and the serum iPTH concentrations should range from 150 to 300 pg/mL in patients who suffer from chronic kidney disease (CKD) stage 5 (ESRD) (14). However, several studies still report a high prevalence of hyperphosphataemia (15),(16); only 5.5% of the patients achieved all of the target levels of the K/DOQI, thus indicating that the proportion of the patients who achieved the K/DOQI recommendations was very low and that they may require new approaches for the management of bone and mineral abnormalities (16). Our study was aimed at assessing the haemodialysis adequacy by URR measurement, the NKF-K/DOQI target in bone metabolism and the disease in CKD stage 5 (ESRD) for Calcium, Phosphorus and Ca × P.

Material and Methods

This study was conducted during April to September 2011. The individuals for the study were selected from the Haemodialysis Unit, Prathima Hospital, Karimnagar, Andhra Pradesh, India. The individuals are End Stage Renal Disease (ESRD) patients who were on chronic haemodialysis for >1year. A total of 35 individuals were studied. An informed consent was obtained from all the 35 individuals. All the 35 individuals were explained the nature of the study. This study was approved by the Institutional Ethical Committee (IEC).

Inclusion Criteria
Male and female patients between 20 to 60 years of age, who were suffering from End Stage Renal Disease (ESRD), who were on chronic haemodialysis treatment. Patients who were on regular (3 times per week) haemodialysis sessions.

Exclusion Criteria
Patients who were not on phosphate binders.

Haemodialysis was performed by using a Fresenius Medical Care (4008S) haemodialyzer machine, on ESRD patients with permanent arterioveinous fistulas. It was indicated in patients whose glomerular filtration rate (GFR) was below 15mL/min. The time duration for HD was 4 hours and it was performed thrice a week. HD was advised in all the ESRD patients. Urea was measured by Berthelot’s enzymatic method (17) by using a kit which was supplied by the Nicholas Piramal Diagnostics. Calcium was measured by the Arsenazo III method (18) by using a kit which was supplied by Liquimax calcium, Avecon Healthcare, Pvt. Ltd. Phosphorus was measured by the modified Metol method (19) by using a kit which was supplied by Excel diagnostics. All the parameters were measured on an ERBA chem 7 semi-auto analyzer. The urea reduction ratio (URR) as expressed in % was calculated by (1); URR = 100 × [1- (Ct/C0)] in which Ct is the postdialysis BUN and C0 is the predialysis BUN. Serum calcium was adjusted for the albumin levels by using the170conversion factor; Corrected Calcium (mg/dL) = Total Calcium(mg/dL) + 0.0704 × [34 – albumin (g/L)] (20). The Ca × P product in mg2/dL2 was calculated by multiplying the corrected calcium concentration by the phosphorus concentration, both in mg/dL (21).


TThe data was obtained from 35 patients. The serum parameters were urea, calcium and phosphate. The data analysis was done by using SPSS, version 17. Parametric statistics like Mean, SD and the Student’s t-test (paired) were applied for the continuous data.

Demographic Distribution
Most of the patients were from the district of Karimnagar.

Demographic Data
Age and Sex Distribution: The mean age (mean ± S.D.) of the study patients was 54.6 ± 8.6 years. Eighty percent were male patients.

Parametric Data
The Urea Reduction Ratio (mean ± S.D.) in 35 patients was 66.4 ± 15.6 %. The pre-dialysis urea (mean ± S.D.) level was 142.3 ± 46.5 and the post-dialysis urea (mean ± S.D.) level was 43.0 ± 18.9. The Student’s t-test (paired) was done on pre-dialysis and post-dialysis serum urea, which showed significant (p<0.001) reduction. The mean serum calcium (mean ± S.D.) level was 8.59 ± 0.78 mg/dL. 48.5% of the patients had serum calcium levels which were below the target levels. In 37.2% of the patients, the serum calcium levels were within the target levels. 14.3% of the patients had serum calcium levels which were above the target levels. The mean serum phosphorus (mean ± S.D.) level was 5.82 ± 0.98 mg/dL. 34.3% of the patients had serum phosphorus levels which were within the target levels. 65.7% of the patients had serum phosphorus levels which were above the target levels. The mean Ca × P product (mean ± S.D.) level was 49.88 ± 8.42 mg2/dL2. 68.6% of the patients had serum Ca × P product levels which were within the target levels. 31.4% of the patients had serum Ca × P product levels which were above the target levels. (Table/Fig 1) Shows the distribution of the ESRD patients as per the NKF-K/DOQI targets for Ca, P and Ca × P.


In this current study, we determined that the NKF-K/DOQI target for URR was achieved whereas for Ca, P and Ca × P, it was not completely achieved. The median URR increased from 58.9% to 69.5% from 1990 to 1997, respectively (22). From 1993 to 1997, the mean URR increased from 62.7% to 68.0% (23). The percentage of the patients who received a URR value of ≥65% increased from 43% in 1993 to 72% in 1997. In this study, there was a significant (p<0.001) reduction in the pre-dialysis and post-dialysis serum urea levels. The mean urea reduction ratio (URR) was 66.4 % (the adequate URR was >65%), thus suggesting an adequate dialysis. One study reported a URR of 72% (24). Another study reported URRs of 67.1% and 66.3 % (25). This present study showed that the mean serum calcium (mean ± S.D.) was 8.59 ± 0.78 mg/dL and that it was within the target levels(8.4 to 9.5 mg/dL). 48.5% of the patients had serum calcium levels which were below the target levels. 37.2% of the patients had serum calcium levels which were within the target levels. 14.3% of the patients had serum calcium levels which were above the target levels. Similar studies showed that 43% (26) and 59% (21) of the patients had serum calcium levels which were above the target levels. Despite substantial improvements over the last decade in the management of dialysis patients, little progress has been achieved in the control of the serum phosphorus levels. In 1988, Lowrie and Lew (27) analyzed data from 12000 haemodialysis patients and found that their mean serum phosphorus level was 6.2 mg/dL. Twelve years later, Block et al. (15) showed that hyperphosphataemia remained a relevant clinical problem. In our study, the mean serum phosphorus level was 5.82 ± 0.98 mg/dL and it was above the target levels (3.5 to 5.5 mg/dL). 65.7% of the patients had a phosphorus level which was greater than 5.5 mg/dL. Similar studies showed that 34% (26) and 49% (21) of the patients had serum phosphorus levels which were above the target levels. The available evidence is limited, but convincing, that the primary outcome (increased death rate) and the secondary outcome (extra-skeletal calcification) were related to the Ca-P product. If this product exceeded 55, there would be an increased risk for the development of calcification and possibly, an increased risk for a lower patient survival. The DOPPS study (16) demonstrated that the percentage of patients who were within the K/DOQI guideline range remained surprisingly low, with 56.5% of the patients having a Ca × P level of <55 mg2/dL2. Our results showed slightly better results for the Ca × P control. The mean Ca × P level was 49.88 ± 8.42 (<55 mg2/dL2), with 68.6% of the patients having a Ca × P level of <55 mg2/dL2, thus proving again, that difficulties still existed in achieving the recommended levels of Ca × P. Other studies showed that 67% (26) and 56% (21) of the patients had serum Ca × P levels which were within the target levels.


The NKF-K/DOQI target for URR was achieved, thus suggesting that adequate dialysis dosing was possible in this set-up. One reason could be that the adequate treatment time was enough in most of the cases to achieve the URR targets, whereas for Ca, P and Ca × P, the NKF-K/DOQI targets could be called as partially achieved. The reason for this may be that multiple factors were involved, such as the adequacy of the oral phosphate binders, the education on dietary phosphate reduction and the requirements of Vitamin D supplementation and the parathyroid status, to name a few. To conclude, a strict and comprehensive approach is required to achieve the latest NKF-K/DOQI targets for bone and mineral metabolism and disease to reduce the morbidity and the mortality. However, large scale studies are required to make any solid conclusions.


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Tables and Figures
[Table / Fig - 1]
DOI and Others

DOI: JCDR/2012/4057:2009

Date Of Submission: Jan 27, 2012
Date Of Peer Review: Feb 21, 2012
Date Of Acceptance: Mar 19, 2012
Date Of Publishing: Apr 15, 2012

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