Bone disorders in chronic kidney disease patients: A teaching hospital based study in central India

Abstract

Background: Kidneys and bones are the major metabolic buffer systems in our body that help us to maintain the internal milieu. Disease in one naturally is going to affect the other in long term. The association between the two has long been known but not brought into the limelight till the recent decades. This increase in the importance being given to the mineral abnormalities is due to its high association with the cardiovascular disease and death due to CVD. Chronic kidney disease (CKD) is a progressive loss in renal function which involves in deterioration in mineral homeostasis with disruption of normal serum and tissue concentration of phosphorus and calcium. Also changes in circulating levels of hormones parathyroid hormone (PTH), calcitriol (1, 25(OH) 2 D), and fibroblast growth factor-23 (FGF-23). Here our aim is to study the prevalence of markers associated with MBD in CKD stage 3-5 patients. Patients with CKD stage 3-5 were included in this observational study with all necessary parameter. X-RAY abdomen and echocardiography was done to look for evidence of vascular and valvular calcification respectively. Aims and Objectives: To evaluate the bone disorders in chronic kidney disease patients.Material and Methods: This retrospective study was conducted in Department of Medicine, RKDF Medical College Hospital & Research Center, Bhopal, Madhya Pradesh, India. All CKD patients from stage 3-5 were included. Likewise Patients having pre-existing systemic diseases like SLE/RA, liver disease, patients on steroids or other drugs which have effect on bone metabolism like calcium, phosphate binders, vit D, bisphosphonates, patients with primary bone diseases, patients on maintenance hemodialysis and h/o fracture in last. Statistical analysis was done using SPSS software.Results and Observations: A total of 175 patients (132 males, 43 females) (M:F = 3:1) were included in this study with a mean age of 50.54 years. Among CKD stages 3 to 5, the prevalence of hypocalcemia was 21.5%, 33.9% & 48.9%, hyperphosphatemia was 11.1%, 25.5% & 63%, hyperparathyroidism was 48.1%, 67.3% & 89.1%, high total alkaline phosphatase was 0%,5.9% & 45.7%, low 25-OH-vit D was 59.2%, 70.6% & 79.4% respectively. Low 25 (OH) D levels, hyperparathyroidism, and hyperphosphatemia were the noticeable markers of CKD-MBD in our patients. Mineral bone disorder are common in CKD patients which start in early CKD stages & worsen with disease progression that causes morbidity and decreased quality of life.Conclusion: Diabetic and Non-diabetic CKD-MBD are not different and hence need not be addressed separately. Serum bone marker assay should be included in CKD-MBD screening. The screening should begin in the early stage of CKD. In conclusion, we observed Low 25 (OH) D levels, hyperparathyroidism, and hyperphosphatemia were the noticeable markers of CKD-MBD in our patients. Mineral bone disorder are common in CKD patients which start in early CKD stages & worsen with disease progression that causes morbidity and decreased quality of life. Hence, this shows the importance of early recognition, understanding of their patho-physiological consequences & planning management strategies to prevent their progression, thereby reducing the cardiovascular morbidity & mortality.