• Hawley C. Calcium x phosphate product. Nephrology 2006 Apr;11(S1):S206-8.



• Hawley C. Calcium x phosphate product. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Oct. 7 p. [27 references]

This is the current release of the guideline.

Chronic kidney disease

Management
Treatment

Family Practice
Internal Medicine
Nephrology
Pediatrics

Physicians

To explore the evidence to support an appropriate target range for the calcium x phosphate product in patients with renal impairment by looking at extraskeletal outcomes

Adults and children with chronic kidney disease

Maintenance of appropriate serum calcium x phosphate product (considered but not recommended)

• Vascular calcification
• Cardiovascular mortality
• Mortality

Searches of Electronic Databases

Databases searched: MeSH terms and text words for kidney dialysis were combined with MeSH terms and text words for serum calcium. This search was carried out in Medline (1966 to April Week 3 2005). The Cochrane Renal Group Trials Register was also searched for calcium and phosphate trials not indexed in Medline.

Date of searches: 30 April 2005.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding calcium x phosphate product in patients with chronic kidney disease from the following groups were discussed: UK Renal Association, Canadian Society of Nephrology, European Best Practice Guidelines, and International Guidelines.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence

Suggestions for Clinical Care

(Suggestions are based on Level III and IV evidence)

• In Stage 5 kidney disease, serum calcium (albumin-corrected) x phosphate product < 4.0 mmol/L is recommended. (Level III evidence – cohort data; strong effect; consistent finding)

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate management of serum calcium x phosphate levels in patients with chronic kidney disease

Not stated

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Hawley C. Calcium x phosphate product. Nephrology 2006 Apr;11(S1):S206-8.



• Hawley C. Calcium x phosphate product. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2005 Oct. 7 p. [27 references]

Not applicable: The guideline was not adapted from another source.

2005 Oct

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Author: Carmel Hawley

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on June 5, 2008. The information was verified by the guideline developer on June 11, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.