Tracing and comparing serum, specific, bone biomarkers in patients with secondary hyperparathyroidism

Abstract

Bone and mineral disorders (BMDs) in chronic kidney disease (CKD) are increasingly being studied, and prophylaxis and treatment are conducted, but they still remain one of the most severe systemic illnesses in patients with CKD. In patients with end-stage CKD and secondary hyperparathyroidism, accompanying metabolic disorders of calcium and phosphorus homeostasis may lead to pathological changes in bone and blood vessels, which increase the risk of bone fractures and cardiovascular (CV) events. High levels of parathyroid hormone (PTH), calcium and phosphorus are associated with increased morbidity and mortality in dialysis patients. Dialysis treatment is a renal replacement method that continues the life of patients with CKD, temporarily improving existing bone pathology, but it more often accelerates its progression. Therefore, the symptoms, developmental and complications of BMD-CKD are demonstrated and manifested in patients with extracorporeal treatment. Treatment of BMD requires constant monitoring of Ca-P exchange, PTH, serum of Vitamin D levels and the protein bone markers - osteocalcin, bone alkaline phosphatase. Despite the systemic use of active metabolites of vitamin D, phosphate binders and calcimimetics, in many patients with secondary hyperparathyroidsm, inadequate biochemical control has been observed. In the Dialysis Clinic at St. Marina University Hospital, Varna, two groups of patients on hemodialysis (HD) and with CKD - 2/3 stage with secondary hyperparathyroidism, were followed and had their serum biomarker levels compared - PTH, bone alkaline phosphatase (BAP), osteocalcin, and vitamin D. The results showed statistically significant differences between the two groups in the investigated serum levels of the indicators.