Profile of incident chronic kidney disease related-mineral bone disorders in chronic kidney disease Stage 4 and 5: A hospital based cross-sectional survey

Abstract

Chronic kidney disease related-mineral bone disorder (CKD-MBD) has been poorly studied in pre-dialysis Indian CKD patients. We aimed to study the clinical, biochemical and extra skeletal manifestations of untreated CKD-MBD in pre-dialysis Stage 4 and 5 CKD patients attending nephrology out-patient clinic at a tertiary care hospital in South India. A hospital based cross-sectional survey including, demographic profile, history of CKD-MBD symptoms, measurement of serum calcium, phosphate, parathyroid hormone, 25 hydroxy vitamin D (25(OH) D) and alkaline phosphatase; lateral abdominal X-rays for abdominal aortic calcification (AAC) and echocardiography for valvular calcification (VC) was carried out. Of the 710 patients surveyed, 45% had no CKD-MBD related symptom. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism (>150 pg/mL) and 25(OH) D levels <30 ng/mL was 66.3%, 59%, 89.3% and 74.7% respectively. Echocardiography was carried out in 471 patients; 96% of whom had VC (calcification score ≥1). Patients with VC were older and had lower 25(OH) D levels than those without. Lateral abdominal X-rays were obtained in 558 patients, 6.8% of whom were found to have AAC, which was associated with older age. Indian patients with incident CKD-MBD have a high prevalence of hypocalcemia, 25(OH) D deficiency and VC even prior to initiating dialysis while AAC does not appear to be common. The association between 25(OH) D deficiency and VC needs further exploration.

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

“…Our results were in accordance with the observations of Valson et al [14] who reported similar clinical symptoms such as bone pain (33.5%), proximal muscle weakness (26.2%), and pruritus (25.5%), but in high percentage as compared to our findings.…”

“…The mean age of our study population was almost similar to other Indian studies like that of Agarwal et al [12] (42±13 years) and Prasad and Murthy [13] (49.3 years with range 17-80) and Valson et al [14] (46.6±13.4 years).…”

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

“…These results supported by results by results obtained by other studies (22,24,28). Hence the importance to achievement of target of the NKF-KDOQI to minimize such complications.…”

Acute Kidney Injury Facilitates Hypocalcemia by Exacerbating the Hyperphosphatemic Effect of Muscle Damage in Rhabdomyolysis

“…By reducing urinary phosphate excretion, AKI can contribute to phosphate retention [6,7]. However, iP levels within the normal range have been noted in renal impairment of eGFR <30 ml/min/1.73 m 2 , and reduction in urinary phosphate excretion is not the sole cause of phosphate retention [21,22]. In addition to reduction in urinary excretion, an increased load is necessary to cause phosphate retention [23].…”