Biochemical markers of bone metabolism in the diagnosis of mineral and bone disorders associated with chronic kidney disease

Abstract

The diagnostic possibilities of using biochemical markers of bone metabolism in patients with secondary hyperparathyroidism (SHPT) and chronic kidney disease (CKD) have not yet been properly evaluated.We analyzed indicators of bone mineral density according to double X-ray absorptiometry, as well as biochemical markers of bone metabolism (OC, CTx, ALP), incl. using a neural network algorithm, in 452 patients with various stages of CKD and in 60 persons of the comparison group (control).It has been established that the levels of biochemical markers of bone metabolism in patients with CKD progressively increase with aggravation of renal failure, and are interrelated with PTH and the presence of SHPT, as well as with the presence of osteoporosis. Estimation of OC, CTx, ALP can be used as a source of additional information about the state of bone metabolism in patients with SHPT and CKD. It should be taken into account that in patients with CKD 4–5, the levels of OC, CTx significantly exceed those in a healthy population, due to both an increase in bone metabolism and a slowdown in the process of degradation and elimination of these markers.Using a neural network algorithm, we proposed reference intervals for these indicators depending on the stage of CKD. The data obtained are the basis for the development of recommendations for the diagnosis of osteopathy in SHPT and CKD, as well as multifactorial prevention and correction of this pathology. Only a comprehensive assessment of the state of the bone will make it possible to objectively assess its condition and choose an effective and safe way to correct the identified violations.