MINERAL BONE DISORDERS IN NAÏVE CHRONIC KIDNEY DISEASE PATIENTS – A COHORT STUDY FROM A TERTIARY CENTRE IN SOUTH INDIA
Abstract
Background: Highest rates of morbidity and mortality in chronic kidney disease (CKD) are encountered with its cardiovascular complications and Mineral Bone Disorders (MBD). MBD is now being recognized as a systemic disorder with far-reaching consequences on the quality of life and is no longer merely restricted to the histomorphometric findings in the bone biopsy.
Objective: Few studies to date are available on the pattern of mineral bone disorders in Indian CKD population. Our primary aim was to study the varied patterns of CKD mineral bone disorders in our center based on biochemical parameters.
Patients & Methods: Cross-sectional study involving 75 newly diagnosed patients with CKD stages G3, G4 & G5D. Patients were categorized into two groups based on their KDIGO CKD staging- Group A – CKD stages G3a, G3b, G4; Group B – CKD stage G5D. The biochemical markers of CKD-MBD, namely, serum calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (PTH), and 25-hydroxyvitamin Vitamin D were measured.
Results: 24 patients were included in group A and 51 patients in group B. The most common underlying native kidney disease was chronic glomerulonephritis (41.3%), followed by diabetic nephropathy (37.3%) and chronic interstitial nephritis (21.3%). The mean age of our study population was 49.5 ± 22.9 years in group A and 54.1 ± 15.77 years in group B.
Conclusions: A higher prevalence of hyperphosphatemia, hypocalcemia and vitamin D deficiency was observed in our CKD cohort. Early identification and treatment of these mineral bone disorders are of paramount importance to prevent complications, retard disease progression and improve quality of life.
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References
20:1638–42.
2. Mani MK. Experience with a program for prevention of chronic renal failure in India. Kidney Int Suppl. 2005 Apr;94: S75–8.
3. Covic, A. et al. Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol. Dial. Transplant. 24,1506–1523 (2009)
4. Moe S, T Drüeke, J Cunningham et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006, 69: 1945–1953
5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). KI, Volume 76 | Supplement 113 | August 2009
6. Ajay K Singh, Youssef MK Farag, Bharati V Mittal Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK (Screening and Early Evaluation of Kidney Disease) study
7. Trends in the prevalence of chronic kidney disease and its risk factors in a general Japanese population: The Hisayama Study. Nephrol. Dial. Transplant. (2010) 25 (8): 2557-2564
8. B. Ghosh, T. Brojen, S. Banerjee, The high prevalence of chronic kidney disease-mineral bone disorders: A hospital-based cross-sectional study. Indian J Nephrol. 2012 Jul-Aug; 22(4):285–291
9. Agarwal SK. Assessment of renal bone mineral disorder in naïve CKD patients: A single-center prospective study. Indian J Nephrol. 2007; 17:96
10. Block G, Hulbert-Shearon T, Levin N, et al. Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic haemodialysis
patients: a national study. Am J Kidney Dis. 1998 Apr; 31:607–17
11. Young E, Albert J, Satayathum S, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005 Mar; 67:1179–87.
12. Dhingra R, Sullivan L, Fox C, et al. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med. 2007 May; 167:879–85
13. Lau WL, Festing MH, Giachelli CM. Phosphate and Vascular Calcification: Emerging Role of the SodiumDependent Phosphate Cotransporter PiT- 1. Thrombosis and hemostasis. 2010;104(3):464-470
14. Paoli, Sara, and Mark M Mitsnefes. “Coronary Artery Calcification and Cardiovascular Disease in Children with Chronic Kidney Disease.” Current Opinion in Pediatrics 26.2 (2014): 193–197.
15. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis,Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Kidney International Supplements, Volume 7, Issue 1, 1 – 59
16. On the pathogenesis of the uremic state. An exposition of the "trade-off hypothesis”. Bricker NS, N Engl J Med. 1972 May 18; 286:1093-9
17. Moallem E, Kilav R, Silver J, NavehMany T, RNA-Protein binding and posttranscriptional regulation of parathyroid hormone gene expression by calcium and phosphate. J Biol Chem. 1998 Feb 27; 273:5253-9.
18. Goto S, Komaba H, Fukagawa M. Pathophysiology of parathyroid hyperplasia in chronic kidney disease: preclinical and clinical basis for parathyroid intervention. NDT Plus. 2008;1(Suppl 3):iii2-iii8.
19. LaClair RE, Hellman RN, Karp SL, Kraus M, Ofner S, Li Q, et al. Prevalence of calcidiol deficiency in CKD: A cross-sectional study across latitudes in the United States. Am J Kidney Dis. 2005;45:1026–33.
20. Jabbar Z, Aggarwal PK, Chandel N, Khandelwal N, Sakhuja V, Jha V. Noninvasive assessment of bone mineral status in Indian CKD population-a crosssectional study. Indian J Nephrol. 2007;17:93
21. Bancha Satirapoj, Pokkrong Limwannata et al Vitamin D insufficiency and deficiency with stages of chronic kidney disease in an Asian population BMC Nephrology 2013, 14:2006
22. Londhey V. Vitamin D deficiency: Indian scenario. J Assoc Physicians India. 2011;59:695–6
23. Awumey EM, Mitra DA, Hollis BW, Kumar R, Bell NH. Vitamin D metabolism is altered in Asian Indians in the southern United States: A clinical research center study. J Clin Endocrinol Metab. 1998;83:169–73.
24. Lo CW, Paris PW, Holick MF. Indian and Pakistani immigrants have the same capacity as Caucasians to produce vitamin D in response to ultraviolet irradiation. Am J Clin Nutr. 1986;44:683–5.
25. Vitamin D levels and patient outcome in chronic kidney disease Ravani, Pietro et al. Kidney International 2009, Volume 75, 88 - 95
26. Mohd Rozita, Mohamad Noorul Afidza, Mustafar Ruslinda et al Serum Vitamin D levels in patients with Chronic Kidney Disease, EXCLI Journal 2013;12:511-520 – ISSN 1611-2156
27. Levin A, Bakris GL, Molitch M, Smulde rs M, Tian J, Williams LA, Andress DL Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease. Kidney Int 71: 31–38, 2006
28. Chunsun Dai, Donna B. Stolz, Lawrence P. Kiss, Satdarshan P. Monga, Lawrence B. Holzman, and Youhua Liu Wnt/β- Catenin Signaling Promotes Podocyte
Dysfunction and Albuminuria J. Am. Soc. Nephrol. 2009: 1997-2008. 29. He W, Dai C, Li Y, Zeng G, Monga SP, Liu Y. Wnt/β-Catenin Signaling Promotes Renal Interstitial Fibrosis. Journal of the American Society of Nephrology : JASN. 2009;20(4):765-776.
30. Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomized controlled trial de Zeeuw, Dick et al. The Lancet, Volume 376, 1543 – 1551
