Epidemiological profile of mineral bone disease in chronic kidney disease stage 4-5.

Anna, T Valson (2011) Epidemiological profile of mineral bone disease in chronic kidney disease stage 4-5. Masters thesis, Christian Medical College, Vellore.


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1INTRODUCTION : Chronic kidney disease has now become an international public health problem affecting 5-10% of the world population. As renal function declines, there is a progressive impairment in the kidney’s ability to regulate mineral homeostasis, leading to altered serum concentrations of calcium, phosphate, parathyroid hormone (PTH), 25 hydroxy vitamin D and fibroblast growth factor 23 (FGF-23), among others. AIM: To study the epidemiological profile i.e the clinical, biochemical and radiological parameters relating to bone mineral disease in CKD Stage 4-5 PATIENTS AND METHODS: A hospital based cross sectional survey was carried out in Stage 4-5 CKD patients, involving standard biochemical tests such as serum calcium, phosphate, PTH, 25 hydroxyvitamin D and alkaline phosphatase; imaging in the form of lateral abdominal X rays and Echocardiography to look for vascular and valvular calcification and a DEXA scan to diagnose coexistent osteoporosis. RESULTS: Of the 710 patients enrolled, 45% had no CKD-MBD related symptom. 73.8% were hypocalcemic (< 8.5 mg%), 58.4% had serum phosphate > 4.5 mg%, 76.5% had PTH > 150 pg/mL and 87.8% had Vitamin D deficiency (< 30 ng/ml). Risk factors for Vitamin D < 15 ng/mL were diabetes, reduced sunlight exposure, BMI > 23, high socioeconomic status and female sex. Vitamin D deficiency was significantly associated with dyslipidemia (elevated total cholesterol, LDL and triglycerides). Vascular calcification was seen in 6.8% and associated with diabetes or hypertension for > 5 years, age > 50 yrs, postmenopausal status, smoking and low BMD. 78% had low BMD (T score < -1), the risk factors for osteoporosis being age > 50 yrs, amenorrhea > 1 year, Vitamin D < 15 ng/ml, low sunlight exposure and S. bicarbonate < 22 mmol/L. 51% had significant valvular calcification (Echocardiographic calcification score ≥ 5), which was associated with PTH levels < 300 pg/mL and S. calcium > 9.5 mg%. CONCLUSIONS: In predialysis Indian CKD patients, widespread hypocalcemia and vitamin D deficiency aggravate hyperparathyroidism and are associated with low BMD and a high prevalence of valvular calcification at a young age. CKD-MBD related complications therefore require a multi-pronged treatment strategy and careful monitoring of biochemical parameters once treatment is initiated.

Item Type: Thesis (Masters)
Uncontrolled Keywords: mineral bone disease ; chronic kidney disease ; stage 4-5 ; Epidemiological profile.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 07:33
Last Modified: 11 Jul 2017 07:33
URI: http://repository-tnmgrmu.ac.in/id/eprint/1402

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