scholarly journals Relationship between anemia and biochemical parameters of mineral bone disorders in chronic kidney disease stages 3-5 pre-dialysis patients

2020 ◽  
Vol 10 (3) ◽  
pp. 187-191
Author(s):  
Shudhanshu Kumar Saha ◽  
Rafi Nazrul Islam ◽  
Muhammad Abdur Rahim ◽  
Sarwar Iqbal
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Kidney Disease ◽  
Biochemical Parameters ◽  
Bone Diseases ◽  
Dialysis Patients ◽  
Bone Disorders ◽  
Metabolic Bone Diseases ◽  
Ckd Stage

Background: Anemia and mineral bone disorders (MBD) accompany chronic kidney disease (CKD) and worsen as CKD progresses. Different biochemical parameters of CKD-MBD have been associated with anemia of CKD but are less well evaluated in low resource settings. In this study, we evaluated the role CKD-MBD disorders as a cause of anemia in CKD non-dialysis patients. Methods: This cross-sectional study recruited 115 patients with CKD who attended outpatient department (OPD) of Nephrology in BIRDEM General Hospital between January and June 2019. Patients, who were on iron, erythropoietin, calcium or vitamin D therapy in any form within the preceding 3 months and patients with known parathyroid disorders, metabolic bone diseases or anemia with definite etiology were excluded. Each patient’s demographic, clinical and biochemical parameters were recorded. Associations between anemia and serum levels of calcium (corrected), phosphate, parathyroid hormone (PTH), 25-hydroxy vitamin D [25(OH)D] and alkaline phosphatase were evaluated. Results: Total patients were 115 including 71 (61.7%) females. Mean age was 57.8 years. Most patients were in CKD stage 4 (43, 37.4%) and 5 (45, 39.1%). Mean duration of diabetes and hypertension were 12.7 and 7.2 years respectively. Mean serum creatinine (mg/dL), hemoglobin (gm/dL), calcium (mg/dL), albumin (gm/L), phosphate (mg/dL), alkaline phosphatase (U/L), PTH (pg/mL) and 25(OH)D (ng/mL) were 3.1, 10.5, 8.7, 37.9, 4.0, 119.1, 211.1 and 15.1 respectively. Hemoglobin in CKD stages 3-5 pre-dialysis patients had positive correlation with calcium and 25(OH)D and negative correlation with phosphate, alkaline phosphatase and PTH. Among these parameters of CKD-MBD, correlation with alkaline phosphatase was significant (r=-0.352, p=0.001) Conclusion: Anemia in CKD patients is multifactorial and this study concludes that CKD-MBD is yet another entity contributing to anemia in such pre-dialysis patients. Birdem Med J 2020; 10(3): 187-191

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

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.

scholarly journals CLINICAL PROFILE OF MINERAL BONE DISORDERS (RENAL OSTEODYSTROPHY) IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
pp. 107-110
Author(s):  
ASHISH KHATTAR ◽  
KARTHIK RAO N ◽  
RAVINDRA PRABHU ◽  
BUDDHI RAJ POKHREL ◽  
SHANTI GURUNG ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Radial Artery ◽  
Renal Osteodystrophy ◽  
Clinical Profile ◽  
Biochemical Tests ◽  
Bone Disorders ◽  
Ckd Stage ◽  
High Prevalence ◽  
The Mean

Objective: The objective of the study was to evaluate the clinical profile of mineral bone disorders (renal osteodystrophy) in chronic kidney disease (CKD) patients. Methods: A retrospective study was performed involving 100 patients above 15 years of age with previously diagnosed chronic renal failure. A series of tests such as biochemical, radiological, and arterial calcifications were monitored. The mean age of subjects in our study was 52.54 years. Results: Biochemical tests revealed that hypocalcemia was present in 54% of the patients, and hyperphosphatemia was seen in 84% of the participants, while only 22% of the participants had high alkaline phosphate (ALP) levels. Radiological tests revealed that 39 patients had aortic calcification, 42 patients had radial artery calcification, and 27 patients had both. Subperiosteal resorption was seen on 29 participants. The majority of the vascular calcification and subperiosteal resorption was seen in patients with CKD Stage 5, and both aortic and radial artery calcifications were significantly associated with subperiosteal bone resorption. Conclusion: The results point toward a high prevalence of derangement in the mineral, vascular and valvular calcifications. Serum total ALP can serve as a biochemical marker to identify a pattern of bone turnover where intact parathyroid hormone is not available. The results highlight that serum phosphorus and Ca × P product levels were significantly associated with both aortic and radial artery calcifications. There was no significant association of these calcifications with serum calcium and ALP levels.

scholarly journals PRE DIALYSIS PATIENTS;

2017 ◽  
Vol 24 (02) ◽  
pp. 267-272
Author(s):  
Syed Hidayet Ali ◽  
Bagwan Das ◽  
Agha Taj ◽  
Santosh Kumar ◽  
Besham Kumar
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
P Value ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
Reduced Body ◽  
Ckd Stage ◽  
Duration Of Disease

Introduction: Chronic kidney disease (CKD) is an alarmingly increasingcondition from day to day andit is assumed that malnutrition is co-existent in patients withchronic renal failure (CRF). Malnutrition also occurs in pre-dialysis patients. Such patientshave reduced body weight, depleted fat (energy) stores, loss of somatic protein (low musclemass) and low levels of different plasma proteins like pre-albumin albumin, transferrin, andothers. Objective: To ascertain the frequency of malnutrition in dialysis independent patientsof chronic kidney disease. Setting: Department of nephrology, Jinnah Postgraduate MedicalCentre Karachi. Duration of study: 6 month from 1 June 2013 – 1 December 2013. Studydesign: cross sectional study. Subjects and methods: Patients with chronic kidney disease(GFR <60ml/min/1.73m2) on conservative management irrespective of cause and sex werestudied. All Patients with CKD stage 3 and onwards i. ecreatinine clearance less than 60ml/min/1.73m2for more than 6 months were considered. Descriptive analysis of these patientswas done by: Calculating mean ± SD for age and duration of disease. Male to female ratiowas calculated. Frequency of malnutrition in undialysed patients was calculated. The effectmodifier of age, gender, duration of disease was controlled through stratification. Chi squaretest was applied and p value ≤0.05 was taken as significant. Result: Out of 137 patients, 80were males and 57 were females and the mean age of patients was 58 ±5.8. Mean duration ofdisease was 5.2 ±1.05. Moderate malnutrition cases were 58(42.3%) while severe malnutritionwas observed in 32(23.35%) cases. Conclusion: Patients of chronic kidney disease were foundto be at risk of malnutrition.

scholarly journals Correlation between Noncompliance Behavior and Biochemical Parameters of Chronic Kidney Disease Patients Undergoing Hemodialysis

2021 ◽  
Author(s):  
Sarita Telma Fernandes ◽  
Sushma Marita Dsouza
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Biochemical Parameters ◽  
Sampling Technique ◽  
Well Being ◽  
Dialysis Patients ◽  
Adherence Behavior ◽  
Cross Sectional ◽  
Dietary Compliance ◽  
Therapeutic Regime

Abstract Background and Objectives Compliance with dietary, fluid, and medication instructions is a critically significant factor for the health and well-being of patients undergoing hemodialysis for an extended period. The current study assessed the correlation between noncompliance behavior and biochemical parameters of chronic kidney disease (CKD) patients undergoing hemodialysis. The study's objectives were 1) to assess patients' noncompliance behavior using a questionnaire, 2) to determine the biochemical parameters of CKD patients having noncompliance behavior, and 3) to find the correlation between biological parameters and noncompliance behavior. Methods A cross-sectional study was conducted from July 12, 2018, to February 10, 2019. A purposive sampling technique was used to recruit the participants, and 100 participants were included in the study. The End-Stage Renal Disease–Adherence Questionnaire was used to assess the non-compliance behavior. Results Most dialysis patients (70%) were compliant with the therapeutic regime, while 30% failed to comply. The study revealed a significant positive correlation between noncompliance behavior and biochemical parameters of CKD patients undergoing hemodialysis (r = 0.578, p < 0.05). Conclusion Noncompliance behavior is significantly correlated with the biochemical parameters among patients with CKD on dialysis. Optimal health is possible through fluid and dietary compliance in these patients. Hence, adherence behavior plays a significant role in the health and recovery of dialysis patients with CKD.

A Study of Lipid Profile in Chronic Kidney Disease Patients

2021 ◽  
Vol 15 (9) ◽  
pp. 3087-3090
Author(s):  
Muhammad Rizwan ◽  
Muhammad Taha Lodhi ◽  
Asim Maqsood ◽  
Tahir Mukhtar Sayed
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lipid Profile ◽  
Chronic Kidney Disease Stage ◽  
Inverse Correlation ◽  
Lipid Profiles ◽  
Kidney Damage ◽  
Disease Stage ◽  
Dialysis Patients ◽  
Ckd Stage

Background and Aim: Chronic kidney disease patients are more likely to develop cardiovascular diseases caused by atherosclerosis accelerated rate and variety of other factors, of which they exhibit the abnormality of lipid profile atherogonic characteristics. The current study aim was to investigate the lipid profile abnormalities pattern in non-diabetic chronic kidney disease patients and to evaluate the association between the lipid profile alteration extent and renal impairment degree. Methods: This cross-sectional study was carried out on 118 chronic disease patients in the Department of Nephrology, Shaikh Zayed Hospital Lahore during the period, from August 2020 to May 2021. All the patients were carefully chosen based on their eligibility criteria. A history was taken, clinical investigation was performed, and biochemical tests were conducted. Blood was drawn for lipid profile analysis after 9 hours abstaining. The Institutional Ethical Committee approved the study and informed consent was taken from each individual. Chronic Kidney Disease as defined by the KDOQI Criteria Kidney damage for three months, defined as functional kidney abnormalities with or without decreased GFR, manifested by either: Pathological abnormalities; kidney damage markers such as changes in blood or urine composition, or abnormalities in imaging tests. GFR of less than 60 mL/min/1.73m2 for 3 months, with or without kidney damage. SPSS version 20 was used for data analysis. Results: The study included 118 patients, 79 (66.9%) of whom were males and 39 (33.1%) were females. The mean age of patients was 49.46 + 9.35 years with an age range of 28 to 78 years. Stage 5CKD patients were 23 who underwent dialysis. Chronic kidney disease patients had lower HDL and higher levels of triglyceride whereas, with chronic kidney disease stage progression, the HDL and TGL levels increased. In both stages 4 and 5 CKD, there is a positive correlation between triglyceride levels and serum phosphorous and TGL and calcium had inverse correlation. Dialysis patients' lipid profiles do not differ from those of non-dialysis patients. Conclusion: Our study found that patients with non-diabetic CKD have high triglyceride levels, low HDL, and had LDL and total cholesterol unchanged levels. As the CKD stage advances and GFR declines, triglyceride increases, and HDL decreases. TGL and serum phosphorous had a positive association in chronic kidney disease stage 4 and 5 whereas TGL and serum calcium had an inverse correlation in stages 4 and 5. Moreover, no significant difference between dialysed and non-dialysed chronic kidney disease patients’ lipid profiles was observed. Keywords: Chronic Kidney Disease; Lipid Profile; Lipid Profile Abnormalities

scholarly journals Vitamin D in Chronic Kidney Disease and Dialysis Patients

Nutrients ◽  
2017 ◽  
Vol 9 (4) ◽  
pp. 328 ◽  
Author(s):  
Guillaume Jean ◽  
Jean Souberbielle ◽  
Charles Chazot
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Dialysis Patients

P1241CALCIFICATIONS IN DIFFERENT VASCULAR BEDS ACROSS THE SPECTRUM OF CHRONIC KIDNEY DISEASE INCLUDING CALCIFIC UREMIC ARTERIOLOPATHY: ARE SKIN PUNCH BIOPSIES USEFUL?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anne Kristine Roendbjerg ◽  
Marianne Rix ◽  
Mette Gyldenløve ◽  
Dorrit Krustrup ◽  
Ilse Vejborg ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Dialysis Patients ◽  
Vascular Calcifications ◽  
Ckd Stage ◽  
Calcific Uremic Arteriolopathy ◽  
Skin Biopsies ◽  
Vascular Beds ◽  
Unaffected Skin

Abstract Background and Aims Accelerated vascular calcification in different vascular beds is common in patients with chronic kidney disease (CKD). A severe form of vascular calcifications is calcific uremic arteriolopathy (CUA) presenting with painful ischemic skin lesions and high mortality. The prognostic value of skin biopsies in relation to CUA is unclear and the prevalence of skin vascular calcifications in different stages of CKD is sparsely described. The aim of the study was to describe the occurence of small vesssel vascular calcifications in unaffected skin biopsies in relation to calcifications in other vascular beds across the spectrum of CKD including CUA. Method A cross-sectional cohort (total, n=39) comprising dialysis patients with current or previous CUA (CKD5D+CUA, n=9), dialysis patients without CUA (CKD5D-CUA, n=12), patients with CKD stage 3-4 (CKD3-4, n=12), and healthy kidney controls (control, n=6). The presence of vascular calcifications in the dermis and subcutis were assessed in 4 mm punch biopsies of unaffected skin from the lateral thigh. The presence of vascular calcification was evaluated by H&E, von Kossa and Alizarin staining. The presence of breast arterial calcifications (BAC) was evaluated by mammography, the abdominal aortic calcification score (AAC) by lateral lumbar X-ray and calcification propensity was measured by T50 reflecting the calcification propensity in blood. Results None of the included patients showed vascular calcifications in skin biopsies. Declining kidney function was associated with presence of BAC, increased AAC and reduced T50 (Table). No significant difference was found between CKD5D+CUA and CKD5D-CUA regarding BAC (p=1.000), AAC (p=0.815) or T50 (p=0.165). CKD5D+CUA compared to all other groups had no difference in BAC (p=0.109) and AAC (p=0.141) but reduced T50 (p=0.004). Dialysis patients (CKD5D±CUA) had significant more BAC (p=0.003), higher AAC (p&lt;0.001) and lower T50 (p&lt;0.001). Conclusion No vascular calcifications were found in punch biopsies from unaffected skin in patients with different stages of CKD including CUA. Despite imaging verified vessel calcification by BAC and AAC and increased calcification propensity by T50. This suggest that conventional punch biopsies cannot be used to identify skin vascular calcification and thereby patients at risk for developing CUA.

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