SAT-110 PREVALENCE, PATTERN AND CHARACTERISTICS OF CKD-MBD IN RIVERS STATE NIGERIA

Abstract

Mineral bone disease (MBD) is a common complication in patients with chronic kidney disease (CKD). Various studies reported a global prevalence between 33% and 67%. However, there is paucity of study of CKD-MBD in Africa and in particular Nigeria. Paucity of information on the prevalence, pattern and characteristics of CKD-MBD in our environment may be contributing to the diagnostic difficulties and suboptimal management of this condition. This study, therefore set out to determine the prevalence, pattern and characteristics of CKD-MBD among adult patients with CKD, ultimately to contribute to improved quality of life and general outcome of these patients. This was a cross-sectional study of one hundred and fifty consecutive consenting CKD patients who fulfilled the inclusion criteria for this study. Detail clinical assessment, biochemical and radiological evaluations for CKD-MBD were conducted. Biochemical investigations included serum calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase while the radiological investigations included X-ray of the skull, spine, wrist and phalanges. The reference values of PTH in CKD stage 3-5 was 16.5-72.7pg/ml and 145-654pg/ml for CKD stage 5D (2-9 times the upper limit of normal for assay). In this study therefore, CKD-MBD was defined as follows:Tabled 1Stages of CKDLow turnover bone diseaseHigh turnover bone diseaseStage 3-5PTH < 16.5pg/mlPTH >72.7pg/mlStage 5DPTH < 145pg/mlPTH >654pg/ml Open table in a new tab The mean age of the patients was 45.1(±11.9) years (range of 22-80 years). There were 90 males and 60 females with male to female ratio of 1.5 : 1. The prevalence of CKD-MBD in the study population was 55.3%. Of this, 61 (73.5%) patients had low turnover bone disease while 22 (26.5%) patients had high turnover bone disease. Symptoms suggestive of CKD-MBD in the study population were bone pain and pruritus occuring in 36.7% and 13.3% of the study population, respectively but present in 34.9% and 12.0% of the CKD-MBD patients respectively. Other symptoms present in the study population included leg swelling in 126(84%), frothiness of urine in 123(82%), vomiting in 109(72.7%), facial puffiness in 102(68%), haematuria in 18(12%) and chest pain in 73(48.7%). The mean values for serum PTH, serum calcium, serum phosphate, alkaline phosphatase and Ca x P product among the CKD-MBD patients were 205.06±112.6 pg/ml, 2.56±0.73mmol/l, 1.63±0.63mmol/l, 109.26±65.57IU/L and 4.07±1.28mmol2/l2, respectively but the values among non CKD-MBD patients were 123.08±120.99pg/ml, 2.32±0.46mmol/l, 1.54±0.57mmol/l, 108.13±51.84I U/L and 3.52±1.32mmol2/l2, respectively. There was hypercalcaemia in 44.6%, hypocalcaemia in 26.0%, hypophosphataemia in 12.0% and hyperphosphataemia in 29.3% of the patients. High alkaline phosphatase was observed in 36.0% while 8.7% had low alkaline phosphatase. There was high calcium x phosphate product in 34.0% of the patients. Hypercalcaemia was the most common biochemical abnormality in this study occuring in 44.6% of the patients while only 6% of those with CKD-MBD had radiological features of CKD-MBD. The prevalence of CKD-MBD in our environment is high and low turnover bone disease is the commonest type.