Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(02): 144-150
DOI: 10.1055/s-0041-1732495
Original Article

Analysis of the Prevalence and Severity of Dysregulated Bone Mineral Homeostasis in Nondialyzed Chronic Kidney Disease Patients

Digishaben D. Patel
1   Department of Physiology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
,
Uday Vachhani
2   Department of Biochemistry, GMERS Medical College, Himmatnagar, Gujarat, India
,
Ajay Rajput
2   Department of Biochemistry, GMERS Medical College, Himmatnagar, Gujarat, India
,
Pratik Raghavani
2   Department of Biochemistry, GMERS Medical College, Himmatnagar, Gujarat, India
,
Deepak N. Parchwani
3   Department of Biochemistry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
,
Sagar Dholariya
3   Department of Biochemistry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Progressive loss of kidney function in chronic kidney disease (CKD) leads to altered mineral homeostasis, reflected by the imbalance in calcium and phosphorus, and has been associated with progression of renal failure.

Aims The aim of this study was to investigate CKD-mineral bone disorder (CKD-MBD)-associated candidate variables and its relationship with parathyroid hormone (PTH), as well as to quantify the prevalence of CKD-associated mineral disturbances in nondialyzed CKD patients.

Materials and Methods This cross-sectional analytical study included 124 CKD patients and 157 control participants. Blood samples were analyzed for serum total calcium, phosphorus, PTH, electrolytes, and other hematological/hemodynamic parameters by standard methods. Suitable descriptive statistics was used for different variables.

Results The 124 patients had a mean age of 50.2 ± 7.8 years with male to female ratio of 1.58; majority of patients had stage 3 CKD (40.32%), and the most common comorbid conditions were diabetes mellitus (n = 78 [62.9%]) and hypertension (n = 63 [50.8%]). A high prevalence of mineral metabolite abnormalities was observed in a patient cohort; overall prevalence of hyperparathyroidism was found in 57.25% patients, hypocalcemia in 61.29%, and hyperphosphatemia in 82.25% patients. Prevalence of abnormal homeostasis (with regard to total calcium, phosphate, and PTH) increased progressively with the severity of disease (analysis of variance; p < 0.05). Significant differences in the mean values of total calcium, phosphorus, alkaline phosphatase, and PTH were seen compared with healthy participants (p < 0.0001). Furthermore, there was a significant positive correlation between serum PTH with serum phosphorous (R 2: 0.33; p < 0.0001), serum creatinine (R 2: 0.084; p < 0.0259), serum potassium (R 2: 0.068; p < 0.0467), and a significant negative correlation with serum total calcium (R 2: 0.37; p < 0.0001).

Conclusions CKD patients are at risk of or may already have developed secondary hyperparathyroidism apparent from PTH-linked derangements in mineral metabolism in predialysis CKD patients. These abnormalities start in early stages of CKD and worsen with disease progression. This accentuates the significance of early recognition of mineral bone disorder, understanding its pathophysiological consequences and scheduling necessary interventions/management strategies to protect the CKD patients from a plethora of complications.

Keywords

chronic renal insufficiency - calcium - phosphorus - PTH


Publication History

Article published online:
14 July 2021

© 2021. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 (2 Suppl 1): S1-S266
    PubMedGoogle Scholar
  • 2 National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease KDOQI. Am J Kidney Dis 2006; 47: S1-S145
  • 3 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. Kidney Int Suppl 2009; 113: S1-S130
    Google Scholar
  • 4 Bello AK, Alrukhaimi M, Ashuntantang GE. et al. Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action. Kidney Int Suppl (2011 2017; 7 (02) 122-129
    CrossrefPubMedGoogle Scholar
  • 5 Tentori F, Blayney MJ, Albert JM. et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS. Am J Kidney Dis 2008; 52 (03) 519-530
    CrossrefPubMedGoogle Scholar
  • 6 Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15 (08) 2208-2218
    CrossrefPubMedGoogle Scholar
  • 7 Rose GA, Blackburn H. Cardiovascular survey methods. Monogr Ser World Health Organ 1968; 56: 1-188
    PubMedGoogle Scholar
  • 8 Morin LG. Direct colorimetric determination of serum calcium with o-cresolphthalein complexon. Am J Clin Pathol 1974; 61 (01) 114-117
    CrossrefPubMedGoogle Scholar
  • 9 Daly JA, Ertingshausen G. Direct method for determining inorganic phosphate in serum with the “CentrifiChem”. Clin Chem 1972; 18 (03) 263-265
    CrossrefPubMedGoogle Scholar
  • 10 Blind E. Measurement of intact parathyroid hormone by an extracting two-site immunometric assay. In: Schmidt-Gayk H, Armbruster FP, Bouillon R. eds. Calcium Regulating Hormones, Vitamin D Metabolites, an Cyclic AMP. Heidelberg: Springer; 1990: 151
    Google Scholar
  • 11 Wenger C. et al. Alkaline phosphatase. In: Kaplan A. et al. Clin Chem The C.V.. St Louis, Toronto: Mosby Co; 1984: 1094-1098
    Google Scholar
  • 12 Chasson AL, Grady HJ, Stanley MA. Determination of creatinine by means of automatic chemical analysis. Tech Bull Regist Med Technol 1960; 30: 207-212
    PubMedGoogle Scholar
  • 13 Chaney AL, Marbach EP. Modified reagents for determination of urea and ammonia. Clin Chem 1962; 8: 130-132
    CrossrefPubMedGoogle Scholar
  • 14 Trinder P. Determination of blood glucose using an oxidase-peroxidase system with a non-carcinogenic chromogen. J Clin Pathol 1969; 22 (02) 158-161
    CrossrefPubMedGoogle Scholar
  • 15 Kruse-Jarres JD. Ion-selective potentiometry in clinical chemistry. A review. Med Prog Technol 1988; 13 (03) 107-130
    PubMedGoogle Scholar
  • 16 Davies MR, Lund RJ, Hruska KA. BMP-7 is an efficacious treatment of vascular calcification in a murine model of atherosclerosis and chronic renal failure. J Am Soc Nephrol 2003; 14 (06) 1559-1567
    CrossrefPubMedGoogle Scholar
  • 17 Cortadellas O, Fernández del Palacio MJ, Talavera J, Bayón A. Calcium and phosphorus homeostasis in dogs with spontaneous chronic kidney disease at different stages of severity. J Vet Intern Med 2010; 24 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 18 Kestenbaum B, Belozeroff V. Mineral metabolism disturbances in patients with chronic kidney disease. Eur J Clin Invest 2007; 37 (08) 607-622
    CrossrefPubMedGoogle Scholar
  • 19 Levin A, Bakris GL, Molitch M. et al. 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 2007; 71 (01) 31-38
    CrossrefPubMedGoogle Scholar
  • 20 Schwarz S, Trivedi BK, Kalantar-Zadeh K, Kovesdy CP. Association of disorders in mineral metabolism with progression of chronic kidney disease. Clin J Am Soc Nephrol 2006; 1 (04) 825-831
    CrossrefPubMedGoogle Scholar
  • 21 Agarwal SK. Assessment of renal bone mineral disorder in naïve CKD patients: A single center prospective study. Indian J Nephrol 2007; 17: 96
    Google Scholar
  • 22 Etta PK, Sharma RK, Gupta A. Study of chronic kidney disease-mineral bone disorders in newly detected advanced renal failure patients: a hospital-based cross-sectional study. Saudi J Kidney Dis Transpl 2017; 28 (04) 874-885
    PubMedGoogle Scholar
  • 23 Vikrant S, Parashar A. Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: a study from a tertiary care hospital in India. Indian J Endocrinol Metab 2016; 20 (04) 460-467
    CrossrefPubMedGoogle Scholar
  • 24 Arora K, Goyal G, Soin D, Kumar S, Arora H, Garg C. Correlation of parathyroid hormone levels with mineral status in end-stage renal disease patients. Indian J Endocrinol Metab 2018; 22 (06) 735-739
    CrossrefPubMedGoogle Scholar
  • 25 Tomasello S, Pharm D. Secondary hyperparathyroidism and chronic kidney disease. Diabetes Spectr 2008; 21: 19-25
    CrossrefGoogle Scholar
  • 26 Holick MF. Vitamin D for health and in chronic kidney disease. Semin Dial 2005; 18 (04) 266-275
    CrossrefPubMedGoogle Scholar
  • 27 Mazzaferro S, Pasquali M, Tartaglione L, Rotondi S, Pirrò G. Fisiopatologia dell’iperparatiroidismo secondario: ruolo di FGF23 e Klotho. [Pathophysiology of secondary hyperparathyroidism: the role of FGF23 and Klotho] G Ital Nefrol 2009; 26 (Suppl. 49) S11-S17
    PubMedGoogle Scholar
  • 28 Cejka D, Herberth J, Branscum AJ. et al. Sclerostin and Dickkopf-1 in renal osteodystrophy. Clin J Am Soc Nephrol 2011; 6 (04) 877-882
    CrossrefPubMedGoogle Scholar
  • 29 Shilo V, Mor-Yosef Levi I, Abel R. et al. Let-7 and MicroRNA-148 regulate parathyroid hormone levels in secondary hyperparathyroidism. J Am Soc Nephrol 2017; 28 (08) 2353-2363
    CrossrefPubMedGoogle Scholar
  • 30 Naveh-Many T, Rahamimov R, Livni N, Silver J. Parathyroid cell proliferation in normal and chronic renal failure rats. The effects of calcium, phosphate, and vitamin D. J Clin Invest 1995; 96 (04) 1786-1793
    CrossrefPubMedGoogle Scholar
  • 31 London GM, Guérin AP, Marchais SJ, Métivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18 (09) 1731-1740
    CrossrefPubMedGoogle Scholar
  • 32 Raggi P, Boulay A, Chasan-Taber S. et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease?. J Am Coll Cardiol 2002; 39 (04) 695-701
    CrossrefPubMedGoogle Scholar