Correlation of serum calcium, phosphorus and alkaline phosphatase levels with eGFR in newly diagnosed chronic kidney disease patients

Background The frequency of low-turnover bone disease (LTBD) in patients with chronic kidney disease (CKD) has increased in past years. This change is important because LTBD is associated with bone pain, growth delay, and higher risk for bone fractures and extraosseous calcifications. LTBD is a histological diagnosis. However, serum markers such as parathyroid hormone (PTH) and calcium levels offer a noninvasive alternative for diagnosing these patients. Objective To describe the prevalence of LTBD in pediatric patients with renal failure undergoing some form of renal replacement therapy, using serum calcium and intact PTH levels as serum markers. Methods In this cross-sectional study, 41 children with CKD undergoing dialysis treatment (31 on continuous ambulatory peritoneal dialysis and 10 on hemodialysis) were included. There were no inclusion restrictions with respect to gender, cause of CKD, or dialysis modality. The children were studied as outpatients. The demographic data, CKD course, time on dialysis, phosphate-binding agents, and calcitriol prescription were registered, as well as weight, height, Z-score for height, linear growth rate, and Z-score for body mass index. Serum calcium, phosphorus, aluminum, PTH, alkaline phosphatase, osteocalcin, glucose, creatinine, urea, cholesterol, and triglycerides were measured. Results There were 20 (48.8%) children with both PTH <150 pg/mL and corrected total calcium >10 mg/dL who were classified as having LTBD[(+)]; the remaining 21 (51.2%) children were classified as having no LTBD[(–)]. The LTBD(+) patients were younger (11.2 ± 2.7 vs 13.2 ± 2.4 years, p < 0.01) but they had no differences regarding Z-scores for height. Linear growth in 6 months was less than expected in both groups (-0.15 ± 0.23 cm/month), but the difference between expected and observed growth was higher in the LTBD(+) group (-0.24 ± 0.14 vs –0.07 ± 0.28 cm/mo, p < 0.03). LTBD(+) patients also had lower serum creatinine (8.69± 2.75 vs 11.19 ± 3.17 mg/dL, p < 0.01), higher serum aluminum levels [median (range) 38.4 (9 – 106) vs 28.1 (9 – 62) μg/L, p < 0.05], and lower systolic blood pressure (112.0 ± 10.3 vs 125.0 ±12.9 mmHg, p < 0.015) and diastolic blood pressure (76.0 ± 9.7 vs 84.5 ± 8.2 mmHg, p < 0.017). A significant correlation was found between PTH and alkaline phosphatase ( r = 0.68, p < 0.001), but not between PTH and aluminum. Conclusion The LTBD(+) biochemical profile was found in 48.8% of the children and was associated with impaired linear growth. Aluminum contamination, evidenced by higher serum aluminum levels, may have had a pathogenic role in these disorders. Higher systolic and diastolic blood pressure levels may be related to higher serum PTH levels.

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The Relationship of Serum Calcium, Phosphorus, and Parathyroid Hormone with Renal Function in Elderly Osteoporotic Patients with No History of Chronic Kidney Disease

Advances in Aging Research ◽

10.4236/aar.2017.64006 ◽

2017 ◽

Vol 06 (04) ◽

pp. 55-60

Author(s):

Hiroshi Yonezu ◽

Hiroshi Mikami ◽

Koichi Oba ◽

Katsutoshi Miyatake ◽

Michihiro Takai ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Serum Calcium ◽

Calcium Phosphorus ◽

History Of ◽

Relationship Of ◽

The Relationship

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Prolonged Hypocalcemia After a Single Dose of Denosumab in Chronic Kidney Disease

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.439 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A216-A217

Author(s):

Akshan Puar ◽

Zeb Ijaz Saeed

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Alkaline Phosphatase ◽

Single Dose ◽

Calcium Carbonate ◽

Kidney Disease ◽

Serum Calcium ◽

Ckd Stage ◽

25 Hydroxy Vitamin D ◽

History Of

Abstract Introduction: Denosumab, a monoclonal antibody that inhibits RANK L (receptor activator nuclear factor-kappa beta ligand), is one of the few medications that can be used to treat osteoporosis in patients with chronic kidney disease (CKD). However, its use is associated with a much higher incidence of hypocalcemia in this patient population. What remains unclear is the duration of hypocalcemia after denosumab use. We describe a case of prolonged hypocalcemia of 9 months in a patient with CKD after a single dose of denosumab. Case: A 64-year-old Caucasian man with a history of bilateral lung transplant for interstitial pulmonary fibrosis and CKD Stage IV was referred to the Endocrinology clinic for evaluation of steroid-induced osteoporosis. Bone density scan was consistent with osteoporosis with the lowest T-score of -2.8 at the left femoral neck, which showed a 25.3% decline from a previous one two years prior. His labs upon initial visit: 25 hydroxy Vitamin D: 36.5 ng/mL (30–100), 1, 25 hydroxy vitamin D 32 pg/ml (19.9–79.3), corrected Serum Calcium 8.9 mg/dL (8.5–10.5), Serum Cr 4.38 mg/dL (0.6–1.4), PTH 157 pg/mL (10–65), Serum Alkaline Phosphatase 61 Units/L (25–125), Urine NTX 39 nM BCE/mM creatinine (21–83). After discussing risks and benefits, he was given a dose of subcutaneous denosumab 60 mg. He had been started on Calcium/Vitamin D (600 mg/400 IU BID) prior to receiving his dose. Keeping in mind the increased risk of hypocalcemia given his history of CKD, his corrected serum calcium was checked one week later, and it was 6.5 mg/dL. The patient was asymptomatic. However, given the severity of his hypocalcemia, he was started on calcitriol 0.25 mcg oral BID and calcium carbonate 1200 mg daily. He did show mild improvement in three days to a corrected calcium of 7.0 mg/dL. His calcitriol was briefly increased to 0.5 mcg BID and calcium carbonate was increased to 1800 mg daily. The regimen was weaned to calcitriol 0.25 mcg daily and previous calcium/Vitamin D dosing later that month. Thereafter, his labs were monitored regularly and there were several unsuccessful attempts made to decrease the calcitriol/calcium carbonate. Given persistent hypocalcemia, other bloodwork including a bone specific alkaline phosphatase and celiac screen were checked which were unremarkable. Finally, nine months after his denosumab dose, calcitriol was discontinued safely. Serum calcium levels have remained stable thereafter. Given prolonged hypocalcemia, it was decided not to administer another dose of denosumab. Conclusion: Patients with CKD who receive denosumab are not only at risk for developing severe, but also prolonged hypocalcemia. Therefore, it is imperative to monitor serum calcium levels, not only immediately after receiving a dose, but serially.

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Value of Calcium and Phosphorous in chronic kidney disease patients under hemodialysis: A retrospective study

Journal of Pathology of Nepal ◽

10.3126/jpn.v2i4.6881 ◽

2012 ◽

Vol 2 (4) ◽

pp. 293-296

Author(s):

S Singh ◽

K Upadhyay-Dhungel ◽

G Aryal

Keyword(s):

Chronic Kidney Disease ◽

Retrospective Study ◽

Kidney Disease ◽

Serum Calcium ◽

Mineral Metabolism ◽

College Teaching ◽

Team Approach ◽

National Guidelines ◽

Medical College ◽

Calcium Phosphorus

Background: Derangements of mineral metabolism occur during early stages of chronic kidney disease (CKD). Mineral metabolism has emerged as important predictors of morbidity and mortality in dialysis patients. This study aims to evaluate the values of calcium and phosphorous in reference to practice guidelines issued by National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) in patients undergoing hemodialysis in KIST Medical College Teaching Hospital.Materials and Methods: It was a retrospective study which included 101 patients who underwent hemodialysis in KIST Medical College Teaching Hospital over a period of three months (October 2010 to December 2010). The laboratory parameters of serum calcium, and phosphorus were evaluated and were compared with that of recommended values by K/DOQI guidelines.Results: The mean values for serum calcium, phosphorus, and calcium-phosphorus product were 8.79 ± 1.48 mg/dL, 5.30 ± 1.32 mg/dL and 46.62 ± 1.96 mg2/dL2 respectively. Forty (40%), 53 (53%) and 76 (76%) cases of CKD patients met K/DOQI target value for calcium, phosphorous and calciumphosphorous product respectively. Twenty one percent of the patients meet the three K/DOQI guidelines and 14% did not meet any of the recommended guidelines by K/DOQI.Conclusion: To achieve all the K/DOQI guidelines multi-disciplinary team approach is crucial. More extensive multicenter studies need to be carried out. It is necessary to develop our national guidelines in future.Journal of Pathology of Nepal (2012) Vol. 2, 293-296DOI: http://dx.doi.org/10.3126/jpn.v2i4.6881

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Bone disease in patients with chronic kidney disease under conservative management

Sao Paulo Medical Journal ◽

10.1590/s1516-31802005000200010 ◽

2005 ◽

Vol 123 (2) ◽

pp. 83-87 ◽

Cited By ~ 3

Author(s):

Carlos Perez Gomes ◽

Maria Inês Barreto Silva ◽

Maria Eugênia Leite Duarte ◽

David Dorigo ◽

Carla Cavalheiro da Silva Lemos ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Alkaline Phosphatase ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Creatinine Clearance ◽

Conservative Management ◽

Bone Disease ◽

Bone Biopsy ◽

Case Series ◽

Calcium Phosphorus

CONTEXT AND OBJECTIVE: Few studies have focused on bone disease in patients with chronic kidney disease under conservative treatment. The objective was to evaluate bone disease in patients with chronic kidney disease. DESIGN AND SETTING: Case series, at the Nephrology Division, Hospital Universitário Pedro Ernesto. METHODS: 131 patients with creatinine clearance from 10 to 60 ml/min/1.73 m² were followed up for at least one year. Serum creatinine, albumin, calcium, phosphorus, alkaline phosphatase, total CO2 (tCO2), intact parathyroid hormone (iPTH), and alkaline phosphatase were measured. Creatinine clearance was calculated from 24-hour urine creatinine measurements and protein ingestion estimates from urea assays. RESULTS: Patients presenting creatinine clearance < 30 ml/min/1.73 m² had higher iPTH values, but normal serum levels for calcium, phosphorus, alkaline phosphatase and tCO2. Patients presenting iPTH values of twice the normal upper limit (144 pg/ml) showed lower tCO2 values. Bone alkaline phosphatase was evaluated in 37 patients with creatinine clearance < 30 ml/min/1.73 m², showing correlation with alkaline phosphatase but not with parathyroid hormone. Bone biopsy on nine patients with creatinine clearance < 30 ml/min/1.73 m² and iPTH > 144 pg/ml showed osteitis fibrosa (4), mild lesion (4) and high turnover (1). CONCLUSION: The present data suggest the importance of early control for iPTH and metabolic acidosis, among patients under conservative management for chronic kidney disease, in order to prevent complications related to bone disease.

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Is Serum Total Alkaline Phosphatase a Useful Tool for Chronic Kidney Disease – Mineral and Bone Disorder Assessment in Non-Dialysis Patients?

Medical Connections ◽

10.33311/medcon.2016.37.1.2 ◽

2016 ◽

Vol 37 (1/2016) ◽

Keyword(s):

Chronic Kidney Disease ◽

Alkaline Phosphatase ◽

Kidney Disease ◽

Dialysis Patients ◽

Total Alkaline Phosphatase ◽

Mineral And Bone Disorder ◽

Bone Disorder ◽

Total Alkaline

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Impact of antithrombotic therapy in the prognosis of atrial fibrillation patients with advanced chronic kidney disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0649 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.M Andreu Cayuelas ◽

S Raposeiras-Roubin ◽

E Fortuny Frau ◽

A Garcia Del Egido ◽

J Seller-Moya ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Antithrombotic Therapy ◽

Anticoagulation Therapy ◽

Bleeding Event ◽

Funding Source ◽

Newly Diagnosed ◽

Bleeding Events ◽

Cox Regression Analysis

Abstract Introduction Chronic kidney disease (CKD) is associated with an elevated thromboembolic and bleeding risk in atrial fibrillation (AF) patients, so the decision of antithrombotic therapy is a challenge. Purpose To analyze mortality, embolic and bleeding events in patients with advanced CKD and AF. Methods Multicentric retrospective registry on patients with AF and advanced CKD (CKD-EPI <30 mL/min/1.73 m2). For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event Results We analysed 405 patients with advanced CKD and newly diagnosed AF. 57 patients were not treated with antithrombotic therapy (14.1%), 80 only with antiplatelet/s (19.8%), 211 only with anticoagulation (52.1%), and 57 with anticoagulant plus antiplatelet/s (14.1%). During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). Bleeding event rate was significantly lower in patients without antithrombotic therapy (Figure). After multivariate analysis, anticoagulant treatment was associated with higher bleeding rates, without differences in mortality or embolic events (Table). Conclusion Anticoagulation therapy was associated with a significant increase in bleeding events in patients with advanced CKD and newly diagnosed AF. None of the antithrombotic therapy regimens resulted in lower embolic events rate neither benefit in mortality. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by an unconditional grant from BMS-Pfizer

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