Mineral and Bone Disease in Black African Hemodialysis Patients: A Report From Senegal

Seck, Sidy Mohamed; Dahaba, Mohamed; Ka, Elhadji Fary; Cissé, Mouhamadou Moustapha; Gueye, S M; Tal, Ahmet Ould Lemrabott

doi:10.5812/numonthly.4225

Cited by 17 publications

(26 citation statements)

References 19 publications

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“…In agreement with previous studies from Africa and developed countries [7][8][9] , this study has revealed a high prevalence of derangements of biochemical markers of mineral bone disorder. Based on the cut-off values utilized by this study, hyperparathyroidism (PTH>150) was present in 73.4% of the patients and 37% with a stricter cut-off value of 585 ng/ml(9 times the upper normal of our laboratory assay ).…”

Section: Discussionsupporting

confidence: 80%

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Biochemical markers of mineral bone disorder in South African patients on maintenance haemodialysis

2017

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Background and objective: Despite the high mortality and morbidity associated with abnormalities in mineral and bone metabolism in haemodialysis patients, there is limited data on the pattern of mineral bone disorder in African CKD population. Therefore, the purpose of this study was to describe the pattern of mineral bone disease by evaluating biochemical parameters in patients on maintenance haemodialysis (MHD). Methods: We evaluated the serum/plasma intact parathyroid hormone (iPTH), corrected calcium, phosphate, total alkaline phosphatase (TALP) and 25 -OH vitamin D levels of two hundred and seven patients undergoing MHD at two dialysis centers in Johannesburg. Results: The MHD patients (133 men, 74 women) had a mean age of 54.5±15.6 years with a median dialysis vintage of 24 months (IQR, 12-48) and a mean kt/V of 1.45±0.28. The prevalence of hyperparathyroidism (iPTH >150 pg/ml), hyperphosphataemia, hypocalcaemia and 25-OH vitamin D deficiency (<30 ng/ml) was 73.4%, 57.0%, 20.3% and 80.7 % respectively. The combination of markers of bone turnover (iPTH >150pg/ml and TALP> 112 U/L) suggestive of high turnover bone disease, was present in 47.3 % of the study population. In multiple-logistic regression analysis, the odds ratio for developing hyperparathyroidism with hypocalcaemia and hyperphosphataemia were 5.32 (95% CI 1.10 -25.9, P = 0.03) and 3.06(95 % CI 1.15 -8.10, P=0.02) respectively. Ninety eight (47.3%) of the MHD patients had iPTH within the recommended kidney disease improving global outcome (KDIGO) guidelines. Conclusion: Secondary hyperparathyroidism and 25-OH vitamin D deficiency were common in our haemodialysis patients. Hypocalcaemia and hyperphosphataemia were strong predictors for developing secondary hyperparathyroidism.

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Section: Discussionsupporting

confidence: 80%

“…In addition, we found phosphataemia to have remained closely related to log-transformed PTH in multivariate linear regression. The strength of our study is the larger sample size compared to other previous studies from Africa 7,9,25 .…”

Section: Discussionmentioning

confidence: 80%

Biochemical markers of mineral bone disorder in South African patients on maintenance haemodialysis

2017

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“…The first group low-turnover renal osteopathy (adynamic bone disease), the second was the optimal group, target of the NKF-KDOQI and the third high turnover bone disease (2 nd hyperparathyroidism), the three groups represented by 27%, 23% and 50% respectively. Comparable results obtained by other studies, 30%, 25%, 45%, respectively (34), 13%, 22%, 55%, respectively (35), likewise 18%, 33% and 49% respectively (36). However, these results expressed need for more expensive medication to control secondary hyperparathyroidism to achieve the target of the NKF -KDOQI.…”

Section: Summary Of Qol Responses In In Different Study Groupssupporting

confidence: 62%

“…Only associations toward worsened QOL variables were found with increasing HD duration and iPTH level respectively; functional status (r=0.37; P=0.05) (r=0. 36 …”

Section: Correlation Between Qol and Study Parametersmentioning

confidence: 99%

The Impact of Chronic Kidney Disease - Mineral and Bone Disorder on the Locomotor System and Quality of Life in Hemodialysis Patients

Fouad¹,

Boraie²

2015

Turk Neph Dial Transpl

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OBJectIVe: Chronic kidney disease -mineral and bone disorder (CKD -BMD) is a worldwide challenge in hemodialysis patients (HD). Widespread use and improved methods of HD may have changed the spectrum of locomotor system disorders in this population. Locomotor system disorders have an impact on health-related quality of life (QOL). The objective of this study was to assess the effect of CKD-BMD on the locomotor system (bone, joint, muscle, tendon and bursa) and document the prevalence of locomotor system disorders in HD populations and its impact in QOL. MAterIAL and MetHOds:550 HD patients were enrolled in this study. Each HD patient received complete locomotor system examination and specific diagnostic investigation. iPTH level classified study population into three groups. Group 1. (149 patients) iPTH level < 100 pg/ml, low-turnover renal osteopathy, Group 2. (126 patients) iPTH from 150-300 pg/mL, Group 3. (275 patients) iPTH > 300 pg/ mL, high turnover bone disease. Patients were offered a self-administered QOL questionnaire, which assessed various QOL variables. resuLts: 75% of hemodialysis patients suffered from one or more locomotor system disorders and the commonest was bone pain 60%, followed by muscle cramps 36%, proximal muscle weakness 30%, osteoarthritis 25%, osteoporosis 16%, rotator cuff syndrome15%, gout pre-HD 12.5%, carpal tunnel syndrome 12%, bone fracture 7%, fibromyalgia 7%, tenosynovitis 6%, periarticular calcification 5%, Dupuytren's contracture 2%, septic arthritis 0.9% and osteomyelitis 0.9%. The three studied groups were represented by 27%, 23% and 50% respectively. The prevalence of osteoarthritis, muscle cramps, bone pain, spontaneous bone fracture and osteoporosis were higher in the third group. 30% of our HD patients completed the QOL questionnaire without assistance and their mean functional status, psychological status, pain scale, fatigue scale, global assessment and joint count were 3.24±2. 24, 3.13 ±1.67, 4.07 ±1.7, 4.95 ±1. 8, 3.97 ±1.55 and 9.65±9.95 respectively. QOL variables pronouncedly worsen in HD patients, however the second group patients have a better quality of life than other groups (P<0.001).cONcLusION: Locomotor system involvement is still very common in our HD patients, especially in high turnover bone disease group and can compromise the QOL.

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“…CKD-related MBD (CKD-MBD) is a worldwide challenge in hemodialysis patients [9]. CKD is characterized by the decline of kidney function within long period [10].…”

Section: Resultsmentioning

confidence: 99%

“Alterations in Parathormone, Calcium and Phosphorus Levels in CKD Patients on Maintenance Haemodialysis in a Hospital Setting in Punjab.”

Bansal

Gahlot

Prasher

et al. 2017

Asian J Pharm Clin Res

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Objective: Many people who have severe chronic kidney disease (CKD) will eventually develop kidney failure and will require dialysis. The control of parathormone (PTH), phosphorus, and calcium metabolism is one of the objectives in an adequate dialysis protocol. Therefore, we conducted this study to describe alterations in PTH, calcium, and phosphorous homeostasis in patients with CKD on hemodialysis in our center. Our study also aimed to find an association between hormonal and biochemical abnormalities in CKD patients, who have been on hemodialysis for ≥5 months and comparing the results obtained with that recommended by Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Methods:This was a hospital-based cross-sectional observational study. The study population of 330 patients (>18 years) on maintenance hemodialysis coming to dialysis Unit of Department of Medicine of Gian Sagar Hospital, Ramnagar (Patiala), over a period of 3 years (2012)(2013)(2014)(2015), were enrolled in the study. Each patient was considered only once for the study. In addition, biochemical analysis of serum intact PTH (iPTH), corrected calcium, phosphorus, total alkaline phosphatase (tALP), serum creatinine, blood urea, serum albumin, and hemoglobin of all cases was done using fully automated equipment. All statistical analyses were performed using SPSS statistical software, version 17. Results:The study population of 330 patients comprised adults, mainly illiterate (54.5%) predominantly belonging to the rural (66.4%) strata with a mean age of 52.67±15.05 (range: 25-98 years). The abnormality in the laboratory profile of the patients was found to be hyperparathyroidism in 40.3% as compared to hypoparathyroidism in 33.5% and normal iPTH levels in 26.2%. Hypocalcaemia was detected in 50.6% and hyperphosphatemia in 62.1% of the patients. There was statistically significant association of serum iPTH, with corrected calcium and phosphorus (P=0.032 and P=0.035, respectively). Corrected calcium was also significantly associated with phosphorus (P=0.001) and tALP (P=0.007). Conclusion:We showed in the present study that disorders of mineral metabolism are common in hemodialysis patients and that only a small proportion adheres to the targets as advised in the KDIGO guidelines for bone metabolism and disease in CKD. We demonstrated that these disorders are associated with important negative clinical outcomes, such as increased all-cause lack survival, more muscle and bone problems. Our findings, therefore, support a strict control of mineral metabolism in dialysis patients. Further research and progress in this area are required to establish a more rational approach with a view toward improving patient outcomes.

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Mineral and Bone Disease in Black African Hemodialysis Patients: A Report From Senegal

Cited by 17 publications

References 19 publications

Biochemical markers of mineral bone disorder in South African patients on maintenance haemodialysis

Biochemical markers of mineral bone disorder in South African patients on maintenance haemodialysis

The Impact of Chronic Kidney Disease - Mineral and Bone Disorder on the Locomotor System and Quality of Life in Hemodialysis Patients

“Alterations in Parathormone, Calcium and Phosphorus Levels in CKD Patients on Maintenance Haemodialysis in a Hospital Setting in Punjab.”

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