Chronic Kidney Disease –Mineral Bone Disorder (CKD- MBD) – Further Insight at the Indian patients.

Mudassir Maqbool Wani ,Imtiyaz Ahmad Wani

doi:10.33883/jms.v22i3.500

Abstract

The kidneys play an important role in maintaining normal serum calcium (Ca) and phosphorous (P) concentrations. Chronic kidney disease (CKD) is associated with significant disturbances in bone and mineral metabolism, leading to altered serum concentrations of Ca, P, vitamin D and parathyroid hormone (PTH)1,2,3. These changes are initially detected when the glomerular filtration rate (GFR) falls to ≤60 mL/min and are nearly uniform as GFR drops to <30ml/min2,3. This leads to a number of bone abnormalities previously called “renal osteodystrophy”, renamed as CKD-Mineral Bone Disorder (CKD-MBD) by National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) consensus group4 . CKD-MBD is a systemic disorder manifested by either one or a combination of a) abnormalities of Ca, P, PTH or vitamin D metabolism, b) abnormalities in bone turnover, mineralization, volume, linear growth or strength c) vascular or soft tissue calcification. This has over time been expanded to include left ventricular hypertrophy, hypertension, immune dysfunction and inflammation5,6.

Highlights

The kidneys play an important role in maintaining normal serum calcium (Ca) and phosphorous (P) concentrations
Treatment naïve Indian CKD patients have a high prevalence of disturbances of mineral metabolism including secondary hyperparathyroidism, vitamin D deficiency, abnormal BMD, valvular and vascular calcification even before initiating dialysis[10,11]
Spectrum of CKD-MBD has been studied in Indian CKD patients, especially in the pre-dialysis stage[3,12,13,14].Etta et al found a high prevalence of hypocalcemia (64.2%), hyperphosphatemia (81.1%), hyperparathyroidism (49.5%) and low Vitamin D levels (89.5%) in newly detected advanced renal failure patients; the prevalence was higher in patients with CKD stage 5 than CKD stage 43

Summary

Introduction

The kidneys play an important role in maintaining normal serum calcium (Ca) and phosphorous (P) concentrations. For CKD-MBD diagnosis and management, several global or local clinical guidelines have been published based on data from non-Asian patients especially Caucasians[4,5]. Because of the paucity of sufficient registry data many Asian countries including India adopt global guidelines, but it is many a time difficult to apply them to local patients, as there are differences in access to diagnostic and therapeutic modalities.

Results

Conclusion