Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) : Evaluation of Management Practices for Secondary Hyperparathyroidism and Vascular Calcification in the Absence of Next-Generation Phosphate Binders (2023- 2025)

Abstract

Background and objectives: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a complex syndrome combining secondary hyperparathyroidism (SHPT), disturbances of calcium-phosphate metabolism, and vascular calcification (VC). In resource-limited countries, the unavailability of next-generation phosphate binders (sevelamer, lanthanum carbonate, sucroferric oxyhydroxide) and intravenous calcimimetics (etelcalcetide) seriously compromises optimal management. This study aimed to evaluate current therapeutic practices, their compliance with the revised 2017 KDIGO guidelines (2025 update), and their impact on biological parameters and vascular calcification. Methods: An analytical cross-sectional study of 120 chronic hemodialysis patients followed at the CNHU-HKM dialysis center. Clinical, biological (intact PTH, corrected calcium, phosphorus, 25-OH vitamin D, FGF-23, alkaline phosphatase), and imaging data (abdominal radiographs, echocardiography) were collected over an 18-month period (2022-2024). Statistical analysis was performed using SPSS v26 software. Results: Mean intact PTH was 682 ± 401 pg/mL; only 43.3% of patients had a PTH within the recommended target (150-600 pg/mL). Vascular calcification was found in 65.0% of patients. The available therapeutic arsenal was essentially limited to calcium carbonate (81.7%), alfacalcidol/calcitriol (71.7%), and cinacalcet (11.7%). Sevelamer, sucroferric oxyhydroxide, lanthanum carbonate, and etelcalcetide were unavailable. Uncontrolled SHPT was significantly associated with the presence of VC (OR: 3.24; 95% CI: 1.68-6.27; p < 0.001) and with dialysis vintage (r = 0.48; p < 0.001). Conclusion: The absence of next-generation binders and limited access to calcimimetics result in inadequate control of SHPT and a high prevalence of VC. These findings support a revision of drug-access policies, continuing education for healthcare professionals, and the integration of newer therapies into national protocols.