The high prevalence of chronic kidney disease-mineral bone disorders: A hospital-based cross-sectional study

Abstract

Mineral bone disorder (MBD) is an important complication of chronic kidney disease (CKD). However, there are limited data on the pattern of MBD in Indian CKD population. The aim of this study was to describe spectrum of MBD in patients with CKD in our center. This was a hospital-based cross-sectional observational study. Patients with stage 4 and 5 CKD were included in this study. Those receiving calcium supplement, vitamin D or its analogues, and calcimimetic were excluded. Serum/plasma levels of creatinine, albumin, calcium, phosphate, total alkaline phosphatase (TAP), intact parathormone (iPTH), and 25-OH vitaminD (25-vitD) were measured. Radiological survey of bones was carried out in all cases, and echocardiography done in selected patients. Statistical analysis was done using Sigmaplot 10.0 software. A total of 150 patients (114 males, 36 females) were included in this study. Mean age was 45.67±16.96 years. CKD stage 4 and 5D were found in 26% (n=39) and 74% (n=111) of study population, respectively. The most common underlying native kidney diseases in patients of CKD 4 and 5D were diabetic nephropathy (41.03%) and CGN (41.44%), respectively. Median (first quartile, third quartile) values for serum levels of corrected calcium (cCa), phosphate, cCaXPO4 product, TAP, plasma iPTH, and 25-vitD in stage 4 CKD were 8.36 (7.79, 8.91) mg/dL, 4.9 (3.92, 6.4) mg/dL, 41.11 (34.01, 53.81) mg2/dL2, 97 (76.5, 184.25) IU/L, 231 (124.5, 430.75) pg/mL, and 12 (6.98, 23.55) ng/mL, respectively; and in stage 5D CKD were 8.36 (7.66, 8.95) mg/dL, 5.7 (4.23, 6.95) mg/dL, 46.5 (37.16, 54.47) mg2/dL2, 180 (114.5, 276.25) IU/L, 288 (169.75, 625.0) pg/mL, and 18.4 (10.0, 26.4) ng/mL, respectively. Prevalence of hypocalcemia (56.41% vs. 54.95%), hyperphosphatemia (64.10% vs. 70.27%), and hyperparathyroidism (84.62% vs. 88.29%) was not different between patients with CKD 4 and 5D. However, iPTH level outside the target range and increased TAP level were significantly (P<0.001) more common in CKD stage 5D. Multiple logistic regression analysis for hyperparathyroidism revealed significant inverse correlation with cCa in CKD 5D. There were no significant differences in vitamin D status and prevalence of valvular calcification between CKD stage 4 and 5D. X-ray revealed renal osteodystrophy in 8 (5.33%) patients, while it was normal in 118 (78.67%) patients. Secondary hyperparathyroidism, hyperphosphatemia, hypocalcemia, increased TAP, and 25-OH vitamin D deficiency and insufficiency were quite common in CKD 4 and 5 patients. The commonest type of MBD in CKD 4 and 5D was secondary hyperparathyroidism.

Chronic Hyperphosphatemia and Vascular Calcification Are Reduced by Stable Delivery of Soluble Klotho

“…aKL expression levels are decreased in kidneys of patients with early DN. 28,29 Consistent with earlier reports, 26,27 we found that the db/db-eNOS 2/2 mouse model had marked kidney fibrosis and increased ACR as well as hyperphosphatemia. Delivery of AAV-cKL increased serum cKL and FGF23 and reduced serum phosphate in these animals, supporting that sustaining cKL concentrations can overcome diminished renal function to improve mineral metabolism.…”

“…With the loss of activity of the leptin receptor and disruption of eNOS, these animals develop highly elevated blood glucose and progressive renal damage, including glomerular and interstitial fibrosis. 26,27 Because DN is now the leading cause of CKD-MBD, 28,29 understanding the nature of this syndrome is important for identifying potential novel management approaches. The aKL-and Fgf23-knockout mice share key phenotypes associated with CKD-MBD, including uncontrollably elevated serum phosphate as well as ectopic calcification and VC.…”

The assessment of prosthetic needs of ESRD patients and the general population in Poland on the basis of the Eichner classification and teeth number: A brief, preliminary report

“…1 Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) often affects this group and is usually related to secondary hyperparathyroidism. 2,3 The bone abnormalities, including the loss of lamina dura and abnormal trabeculation of alveolar bone, may be the cause of tooth loss. The clinical findings are more severe in the group of ESRD patients than in patients with less advanced stadium of chronic kidney disease (CKD), and with time become more noticeable during dialysis.…”

Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study

“…It is most prevalent among CKD patients receiving dialysis, with published estimates of prevalence ranging from 47 to 80 % [1][2][3][4]. A recent report from the COSMOS study found that most hemodialysis patients (70.5 %) had serum phosphorus levels that were above the normal range recommended by the kidney disease: improving global outcomes (KDIGO) guidelines (3.0-4.5 mg/dL) [4].…”