scholarly journals Metabolic Bone Disease in Chronic Kidney Disease Patients (CKD-MBD) and its Associated Factors at Muhimbili National Hospital in Dar es salaam, Tanzania: A Cross-Sectional Study

2020 ◽  
Author(s):  
Felix Faustin Mungulluh ◽  
Paschal Ruggajo ◽  
Francis Fredrick Furia
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Cross Sectional ◽  
Metabolic Bone

Abstract Background: Metabolic bone disease in chronic kidney disease patients is associated with high morbidity and mortality, and it has been reported to start early in the course of the disease and worsen as the kidney damage progresses. However, the prevalence and factors associated with metabolic bone disease in chronic kidney disease patients in our setting has not been established, so we aimed to determine the prevalence and factors associated with metabolic bone disease among patients with chronic kidney disease at a tertiary Muhimbili National Hospital in Dar es salaam, Tanzania so as to help physicians recognize the patients at risk, diagnose the problem and prevent complications sooner.Methods: This was a hospital based cross-sectional study involving adult patients with chronic kidney disease attending renal unit Muhimbili National Hospital, a tertiary referral center in Dar es Salaam, Tanzania. Systematic sampling technique was employed to get study participants after being given informed consent. In this study, CKD-MBD was defined basing on the abnormality of serum calcium, phosphate or parathyroid hormone level. Data analysis was done using the SPSS version 23.0 software. Results: A total of 300 participants with chronic kidney disease stage 3 and above were included in this study. Majority were male, 198 (66.0%), with a mean age of 53 years. The prevalence of metabolic bone disease was found to be 75.0%. The most common form of metabolic bone disease was hyperparathyroidism 196 (87.1%), followed by hypocalcemia 174 (77.3%) and hyperphosphatemia 82 (36.4%), which was the least common. Factors which were found to be significantly associated with CKD-MBD were the use of calcium supplements, use of phosphate binders, being on dialysis, a calcium rich diet and a low phosphate diet.Conclusion: Metabolic bone diseases are common in patients with CKD at Muhimbili National Hospital. Patients with CKD should undergo serial assessment of phosphate, calcium and parathyroid hormone level, considered together, so as to diagnose metabolic bone disease early and treat those patients who will be found to have persistently or prolonged abnormalities in these bone mineral biomarkers.

scholarly journals Metabolic Bone Disease in Chronic Kidney Disease Patients (CKD-MBD) and its Associated Factors at Muhimbili National Hospital in Dar es salaam, Tanzania: A Cross-Sectional Study

2020 ◽  
Author(s):  
Felix Faustin Mungulluh ◽  
Paschal Ruggajo ◽  
Francis Fredrick Furia
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Cross Sectional ◽  
Metabolic Bone

Abstract Background: Metabolic bone disease in chronic kidney disease patients is associated with high morbidity and mortality, and it has been reported to start early in the course of the disease and worsen as the kidney damage progresses. However, the prevalence and factors associated with metabolic bone disease in chronic kidney disease patients in our setting has not been established, so we aimed to determine the prevalence and factors associated with metabolic bone disease among patients with chronic kidney disease at a tertiary Muhimbili National Hospital in Dar es salaam, Tanzania so as to help physicians recognize the patients at risk, diagnose the problem and prevent complications sooner. Methods: This was a hospital based cross-sectional study involving adult patients with chronic kidney disease attending renal unit Muhimbili National Hospital, a tertiary referral center in Dar es Salaam, Tanzania. Systematic sampling technique was employed to get study participants after being given informed consent. In this study, CKD-MBD was defined basing on the abnormality of serum calcium, phosphate or parathyroid hormone level. Data analysis was done using the SPSS version 23.0 software. Results: A total of 300 participants with chronic kidney disease stage 3 and above were included in this study. Majority were male, 198 (66.0%), with a mean age of 53 years. The prevalence of metabolic bone disease was found to be 75.0%. The most common form of metabolic bone disease was hyperparathyroidism 196 (87.1%), followed by hypocalcemia 174 (77.3%) and hyperphosphatemia 82 (36.4%), which was the least common. Factors which were found to be significantly associated with CKD-MBD were the use of calcium supplements, use of phosphate binders, being on dialysis, a calcium rich diet and a low phosphate diet. Conclusion: Metabolic bone diseases are common in patients with CKD at Muhimbili National Hospital. Patients with CKD should undergo serial assessment of phosphate, calcium and parathyroid hormone level, considered together, so as to diagnose metabolic bone disease early and treat those patients who will be found to have persistently or prolonged abnormalities in these bone mineral biomarkers.

scholarly journals Metabolic Bone Disease in Chronic Kidney Disease Patients (CKD-MBD) and its Associated Factors at Muhimbili National Hospital in Dar es salaam, Tanzania: A Cross-Sectional Study

2020 ◽  
Author(s):  
FELIX FAUSTIN MUNGULLUH ◽  
Paschal Ruggajo ◽  
Francis F. Furia
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Cross Sectional ◽  
Metabolic Bone

Abstract Background: Metabolic bone disease in chronic kidney disease patients is associated with high morbidity and mortality, and it has been reported to start early in the course of the disease and worsen as the kidney damage progresses. However, the prevalence and factors associated with metabolic bone disease in chronic kidney disease patients in our setting has not been established, so we aimed to determine the prevalence and factors associated with metabolic bone disease among patients with chronic kidney disease at a tertiary Muhimbili National Hospital in Dar es salaam, Tanzania so as to help physicians recognize the patients at risk, diagnose the problem and prevent complications sooner.Methods: This was a hospital based cross-sectional study involving adult patients with chronic kidney disease attending renal unit Muhimbili National Hospital, a tertiary referral center in Dar es Salaam, Tanzania. Systematic sampling technique was employed to get study participants after being given informed consent. In this study, CKD-MBD was defined basing on the abnormality of serum calcium, phosphate or parathyroid hormone level. Data analysis was done using the SPSS version 23.0 software.Results: A total of 300 participants with chronic kidney disease stage 3 and above were included in this study. Majority were male, 198 (66.0%), with a mean age of 53 years. The prevalence of metabolic bone disease was found to be 75.0%. The most common form of metabolic bone disease was hyperparathyroidism 196 (87.1%), followed by hypocalcemia 174 (77.3%) and hyperphosphatemia 82 (36.4%), which was the least common. Factors which were found to be significantly associated with CKD-MBD were the use of calcium supplements, use of phosphate binders, being on dialysis, a calcium rich diet and a low phosphate diet.Conclusion: Metabolic bone diseases are common in patients with CKD at Muhimbili National Hospital. Patients with CKD should undergo serial assessment of phosphate, calcium and parathyroid hormone level, considered together, so as to diagnose metabolic bone disease early and treat those patients who will be found to have persistently or prolonged abnormalities in these bone mineral biomarkers.

scholarly journals Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study

2020 ◽  
Author(s):  
Puneet Kishore Bramania ◽  
Paschal Ruggajo ◽  
Rimal Bramania ◽  
Muhiddin Mahmoud ◽  
Francis Fredrick Furia
Keyword(s):  
Total Cholesterol ◽  
Complete Blood Count ◽  
Early Recognition ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Cross Sectional ◽  
Reverse Epidemiology ◽  
Maintenance Haemodialysis

Abstract Background: Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software. Results: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (>4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p<0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01-0.97), p<0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS. Conclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

scholarly journals Prevalence of malnutrition inflammation complex syndrome among patients on maintenance haemodialysis at Muhimbili National Hospital in Tanzania: a cross-sectional study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Puneet K. Bramania ◽  
Paschal Ruggajo ◽  
Rimal Bramania ◽  
Muhiddin Mahmoud ◽  
Francis F. Furia
Keyword(s):  
Total Cholesterol ◽  
Complete Blood Count ◽  
Early Recognition ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Cross Sectional ◽  
Reverse Epidemiology ◽  
Maintenance Haemodialysis

Abstract Background Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software. Results Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (> 4 years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p < 0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01–0.97), p < 0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS. Conclusion Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

Comparison of Metabolic Bone Markers in Diabetic and Non-Diabetic Chronic Kidney Diseases in Government Medical College, Thrissur, Kerala, India

2021 ◽  
Vol 8 (29) ◽  
pp. 2578-2583
Author(s):  
Purnima Eliz Thomas ◽  
Pushpalatha M ◽  
Shajee Sivasankaran Nair ◽  
Sajeevan Kundil Chandran
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Bone Disease ◽  
Bone Markers ◽  
Metabolic Bone Disease ◽  
Serum Levels ◽  
Medical College ◽  
Disease Markers ◽  
Metabolic Bone

BACKGROUND The term ‘Chronic Kidney Disease-Mineral and Bone Disorder’ (CKD-MBD) has been used to describe clinically, the abnormalities in the bone and mineral metabolism associated with CKD. In CKD, serum levels of metabolic bone disease markers generally reflect a high bone turnover state (hyperphosphatemia, hypocalcaemia, hypersecretion of PTH, increased ALP). However, it has been noted that in diabetic CKD patients on regular haemodialysis, there is an impaired secretion of PTH when compared to the non-diabetics on haemodialysis. In this study we intend to evaluate the serum bone markers in both diabetic and nondiabetic CHD patients. If a significant association can be demonstrated between diabetes mellitus and a low bone turnover state, then treatment guidelines can be tailored accordingly in the diabetic CHD patients. METHODS A hospital based cross-sectional study was done on 150 patients attending the Dialysis Unit of Govt. Medical College, Thrissur district, Kerala, India, from March 2014 to March 2015. Estimation of serum FBS, creatinine, calcium, phosphorus, ALP and PTH was done. RESULTS The mean levels of serum phosphorus and PTH are significantly lower in the diabetic CHD population than in the non-diabetics, but mean serum ALP is significantly higher in the diabetic CHD patients. Statistical significance is seen in the serum metabolic bone disease markers except calcium among diabetic and non-diabetic chronic kidney disease. CONCLUSIONS The serum levels of PTH and phosphorus were found to be significantly lower in diabetic CHD patients than in their non-diabetic counterparts. Serum ALP levels were significantly higher in the diabetics. This demonstrates that a relative hypoparathyroidism is prevalent among the diabetic CHD patients and hence, prevention of deterioration of the already existing low turnover bone disease in such patients should be the treatment motto. Avoidance of oral calcium supplements, vitamin D supplements and increased calcium in the dialysate would be ideal, since these can lead to hypercalcemia and further suppress the PTH secretion. KEYWORDS Diabetes Mellitus, Chronic Kidney Disease, Bone Markers

Imaging in Chronic Kidney Disease-Metabolic Bone Disease

2017 ◽  
Vol 30 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Anup J. Alexander ◽  
David Jahangir ◽  
Martin Lazarus ◽  
Stuart M. Sprague
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Metabolic Bone
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