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Welcome to the Nephrology Education in Mineral Metabolism Resource Center
The Education in MINEral Metabolism (EMINEM) project stemmed from a study designed to look at mineral metabolism control in hemodialysis patients across Canada. This project allowed a group of interested Nephrologists to see how well Canadian dialysis centres were reaching the K/DOQI and CSN mineral metabolism targets. As only 17.5 % of patients achieved all the K/DOQI targets and an even smaller proportion, 6.3%, achieved all CSN targets (Hemodialysis International 2010;14:200-210), we decided to develop this EMINEM educational tool.
Using the suggested CSN targets for parathyroid hormone and phosphate as a starting point, we devised a Grid format for classifying individual patients according to their unique mineral metabolism profile. This grid is shown below. The purpose of the Grid was to allow us to present suggested management strategies to move individual patients towards the ideal sector of the Grid.
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The EMINEM Resource Centre is more than just the Grid. For example, in the ARTICLES section, our group will present current articles which may impact on our understanding, or on the therapy of Mineral Metabolism derangements. Articles will be critiqued in a scholarly fashion, and comments and discussion around the critiques are welcomed and encouraged. We also hope that you will suggest articles to be reviewed, and present your own reviews for consideration for display on the site. We would like to encourage DISCUSSION around any aspect of Mineral Metabolism, be it criticisms or comments on the Grid, discussion around the articles reviewed, or any topic of relevance which you would like to see discussed. |
- Patient Profiles
- Low PTH
- Desired PTH
- High PTH
EMINEM Grid
The tabs above represent three patient groupings
- Patients with Low PTH
- Patients with Desired PTH
- Patients with High PTH
Within each PTH grouping are six boxes, all representing patients with different Calcium and Phosphate parameters. In all there are 18 patient profiles. Click these boxes to learn more about these individual patients.
Explore our working group's recommendations about mineral metabolism management and its complexities. These scenarios are theoretical and are not intended to replace clinical decision making. The suggestions and opinions expressed in these recommendations are based on evidence where it is available, but many of the suggestions represent the opinion of our working group, Canadian Nephrologists with significant interest and some expertise in the field. The purpose of the Grid is not to be prescriptive, but rather suggestive.
| Phosphate | Calcium Low/Normal |
Calcium High |
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| Phosphate | Calcium Low/Normal |
Calcium High |
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| Phosphate | Calcium Low/Normal |
Calcium High |
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- Cases
- Article Reviews
- About Us
Click one of cases below:
- Morbidly obese female with ESKD secondary to type 2 diabetes mellitus
- A 63 year old woman is first seen in clinic for assessment of CKD secondary to polycystic kidney disease in 2006
- A 48 year old male on HD for 7 yrs with end-stge renal disease secondary to congenital urinary anomalies
- A 21 year old male on hemodialysis for 18 months
Bone and Mineral Article Reviews
- Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis - Article Review - Dr. Anthony Hodsman
- Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients - Article Review - Marisa Battistella
- Low Socioeconomic Status Associates with Higher Serum Phosphorus Irrespective of Race - Article Review - June Martin
- Serum Levels of Phosphorus, Parathyroid Hormone and Calcium and Risk of Death and Cardiovascular Disease in Individuals with Chronic Kidney Disease - Article Review - Dr. Ross Morton
- Effect of Bone Mineral Target Achievement on Mortality in Incident Dialysis Patients: An Analysis of the United Kingdom Registry - Article Review - Dr. Ross Morton
- Vitamin D Supplementation in CKD: A Systemic Review and Meta-Analysis of Observational Studies and Randomized Controlled Trials - Article Review - Dr. Paul Barre
- The Association Between Prescribed Dietary Phosphate Restriction and Mortality Among Hemodialysis Patients - Article Review - Dr. Paul Barre
- Dietary Reference Intakes for Calcium and Vitamin D – Institute of Medicine - June Martin
- Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): Article Review
- Class review of phosphate binders in Ontario
- An assessment of cinacalcet HCl effects on bone histology in dialysis patients with secondary hyperparathyroidism - Article Review
- Meta-Analysis of Biochemical and Patient-Level Effects of Calcimimetic Therapy - Article Review
- Circulating 25-OH D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D - June Martin
- Comparative effectiveness of paricalcitol versus cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis - Article Review
- Effect of Food Additives on Hyperphosphatemia Among Patients With ESRD - Article Review
- The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer
- Parathyroidectomy: Whom and when?
- Monthly cholecalciferol administration in haemodialysis patients: a simple and efficient strategy for vitamin D supplementation
- Prevalence of abnormal serum vitamin D, PTH, calcium and phosphorus in CKD
- CSN commentary on the 2009 KDIGO clinical practice guideline for the diagnosis, evaluation and treatment of CKD-Mineral and Bone Disorder (CKD-MBD)
- Oral Phosphate Binders in Patients with Kidney Failure: A Review
- Lanthanum carbonate vs. sevelamer hydrochloride for the reduction of serum phosphorous in hemodialysis patients: a crossover study
- Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis
- A randomized, double-blind, placebo-controlled study to assess the efficacy and safety of cinacalcet HCl in participants with CKD not receiving dialysis
- Association of Kidney Function with Coronary Atherosclerosis and Calcification in Autopsy Samples from Japanese Elders: The Hisayama Study
- Cinacalcet Effectively Reduces Parathyroid Hormone Secretion and Gland Volume Regardless of Pretreatment Gland Size in Patients with Secondary Hyperparathyroidism - Article Review - Dr. Paul Barre
- Outcomes predicted by phosphorous in chronic kidney disease: a retrospective CKD-inception cohort study
- Phosphate Removal With Several Thrice-Weekly Dialysis Methods in Overweight Hemodialysis Patients
- Benefits and Harms of Phosphate Binders in CKD: A Systematic Review of Randomized Controlled Trials
