Title: The Correlation between the Biomarkers of Bone and Mineral Disorders in patients with CKD stage 4 and stage 5 patients not on dialysis
Authors: Dr Md. Abdullahel Kafee, Dr Md. Al-Rizwanm Russel, Brig. General Md. Abdur Razzak
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.154
Abstract
Background: Bone abnormalities are found almost universally in patients with CKD requiring dialysis (stage 5D), and in the majority of patients with CKD stages 3–5 because the mineral and endocrine functions disrupted in CKD are critically important in the regulation of both initial bone formation during growth (bone modeling) and bone structure and function during adulthood (bone remodeling).
Objectives: The study was to assess the mineral and bone disorders by investigating biochemical parameter and also with the help of DEXA scan of bone in the patients with CKD stage 4 and stage 5 patients not on dialysis.
Method: In this cross-sectional study serum biomarkers of bone turnover: Bone-specific alkaline phosphatase (BAP) along with parathyroid hormone, 25(OH) vitamin D, and bone mineral density (BMD) using dual absorption X-ray absorptiometry in 176 patients who met the inclusion and exclusion criteria for the enrollment were evaluated.
Results: Out of 176 patients maximum number of patients belongs to age group 48-57 years (28.41%) and the age group 18-27 years has the lowest number of patients (6.82%). total number of patients having deficient Vit-D level were (75%) and insufficient were (20.45%) and only (4.55%) showed sufficient level of Vit-D among the study population. stage 4 and in stage 5 the Vita-D deficient patients were (68.89%) and (81.4%). In stage 5 the level of Vita-D decreases significantly. It also shows that in CKD stage 5 there was no patient with sufficient level of Vita-D . PTH level more than 2 times the upper limit was found in (71.6%) patients and among them (57.1%) patients had BAP values more than the mean value. significant correlation between PTH and PO4 (p=0.001), between PTH and Vit-D (p=0.007), between Calcium and PO4 (p=0.008). There are negative correlation between PTH and calcium (r=-0.119), PTH and Vita-D (r=-0.394), PTH and BMD (r=-0.081), between calcium and PO4(r=-0.392), PO4 and Vit-D (r=-0.311), and PO4 and BMD (r=-0.147).
Conclusion: High turnover could contribute to the development of osteoporosis. Vitamin D deficiency is widespread and seems to have a role in the genesis of hyperparathyroidism and high turnover renal bone disease. 25(OH) vitamin D is now recognized as an important player in maintenance of bone health in CKD
Keywords: Biomarkers, Bone and Mineral Disorders, CKD stage 4 and stage 5.
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