Bone metabolic disorder and its contributing factors in patients with chronic kidney disease; a three-year cohort study

Introduction: The prevalence of bone mineral disorder is best known in end-stage renal disease (ESRD) patients, but less data is available for the earlier stages. Objectives: We aimed to compare the prevalence of bone metabolic disorder at all stages of chronic kidney disease (CKD) and assess its contribution to CKD progression and patients’ outcome. Patients and Methods: In a retrospective cohort study, CKD patients who were under treatment for three years were selected from a nephrology clinic in Tehran, Iran. Patients’ demographic and laboratory data, as well as the outcome of their treatment were gathered and analyzed. Results: In 473 patients with an average age of 61.5, 60.1% were at stage III, 35.8% were at stage IV, and 4.1% were at stage V of CKD. There was a significant relationship between CKD stage and serum phosphate, calcium-phosphate product, and systolic blood pressure (SBP). Furthermore, the patients’ outcome was significantly related to advanced stages of CKD, higher first phosphate level, diabetes mellitus in medical history, and higher stages of SBP. By multiple Cox regression analysis, after adjustment for glomerular filtration rate (GFR), the first serum phosphate level, and the calcium-phosphate product did not contribute to the undesirable outcome. Conclusion: Although bone metabolic disorder is more frequently seen in advanced stages of chronic kidney disease, these changes can be seen even in earlier stages of the disease. The influence of phosphate abnormality in the patients’ outcome should be studied more in earlier stages for better control.

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SUN-255 Calcium phosphate product predicts adverse outcomes in chronic kidney disease: novel insight using trajectory analysis

Kidney International Reports ◽

10.1016/j.ekir.2019.05.660 ◽

2019 ◽

Vol 4 (7) ◽

pp. S264-S265

Author(s):

C.W. Tsai ◽

H.C. Huang ◽

Y.H. Chiu ◽

C.C. Kuo

Keyword(s):

Chronic Kidney Disease ◽

Calcium Phosphate ◽

Kidney Disease ◽

Trajectory Analysis ◽

Adverse Outcomes ◽

Phosphate Product

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Calcium - Phosphate Index: Considerable Indicator in Different Stages of Chronic Kidney Disease

Journal of Medical Science & Research ◽

10.47648/jmsr.2012.v1902.01 ◽

2012 ◽

Vol 19 (Number 2) ◽

pp. 3-6

Author(s):

N Y Mili ◽

Md. E Hoque ◽

S Akhter ◽

N S Lovely

Keyword(s):

Chronic Kidney Disease ◽

Calcium Phosphate ◽

Kidney Disease ◽

Serum Calcium ◽

Phosphate Level ◽

Ckd Stage ◽

P Index ◽

Group A ◽

Group B ◽

Serum Inorganic Phosphate

Since the early 1970s. calcium phosphate (Ca-P) index has been regarded as a risk factor for extra skeletal calcification. tumoral calcinosis and increased cardiovascular event and death. The general consensus was not to exceed 70 ing2h1Lt (5.6 unno1/1,2) in chronic kidney disease. The present study was done to find out the Ca - P index in different stages of (CKB) patients to assess the risks of the patients which can be understood and be negotiated. In this study 100 of previously diagnosed chronic kidney disease patients of different stages as CKD stage Ill. IV and stage V were included. Subjects were divided into three groups according to staging of chronic kidney disease : group A (stage 111) were 34 patients, group 8 (Stage IV) were 36 and group C (Stage V) were 30 patients. Mean serum inorganic phosphate level was in group A .5.41 + 2.49. group 8 8.17 + 3.63 and in group C 10.50 + 3.06. Mean serum Calcium level in three groups were in group-A 8.36± 0.74. group- B 8.10± 0.75 and in group- C was 7.43± 1.27 ). Ca - P index was calculated by multiplying the serum calcium and phosphate level. Mean Ca-P index was in group-A 49.39+ 22.95. group B-67.93+ 31.2 and in group-C 90.76+ 24.82. Statistical analysis was done betWeen these groups and it was signifimuly higher in group B than group A ( p< 0.06. group A is group 8). in group C than group A ( p< 0.00. group A vs group C) and in ,group C than group ft ( p< .002. group B vs group C). It was found that as the renal function deteriorates gradually the Ca P index increases and it is highly significantly higher in CKD — V patient than other stages.

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Prevalence of Cardiovascular Risk Factors among Chronic Kidney Disease Patients Undergoing Hemodialysis in a Tertiary Care Center, Kathmandu, Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v21i4.27629 ◽

2019 ◽

Vol 21 (4) ◽

pp. 313-318

Author(s):

A Pokhrel ◽

P. Gyawali ◽

BR Pokhrel ◽

M P Khanal ◽

D N Manandhar ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Calcium Phosphate ◽

Kidney Disease ◽

Care Center ◽

Tertiary Care ◽

Maintenance Hemodialysis ◽

Tertiary Care Center ◽

Phosphate Product

The risk of cardiovascular disease is higher in chronic kidney disease patients compared to the general population and its impact is higher in developing countries compared to the developed countries. With this background in mind, we aimed to evaluate the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center. Chronic kidney disease patients aged 18 years and above who were under maintenance hemodialysis in the hemodialysis unit of Nepal Medical College were included in the study. Pre-dialysis venous blood samples from the participants were collected and analyzed for serum calcium, phosphorus, total protein, albumin and hemoglobin. Calcium phosphate product was calculated. Out of 100 study participants, 52% were male and 48% were female. Age-wise distribution showed 38% of the participants were below 40 years. The mean age of the participants was 45.86 ± 14.4 years. Ninety-three percent had hypertension and 29% had diabetes mellitus. Hypocalcemia was present in 80%, hyperphosphatemia was seen among 81% and high calcium phosphate product was present in 33% of the participants. Low hemoglobin (< 10gm/dL) was found in 86%. The cardiovascular risk trend in the Nepalese chronic kidney disease population is fairly different compared to the western population. Participants were younger. Prevalence of hypertension and diabetes was high. The high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy. Inadequately managed hyperphosphatemia despite the widespread use of phosphorus binders, is still a major clinical challenge in patients on hemodialysis.

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Fibroblast growth factor-23 and calcium phosphate product in young chronic kidney disease patients: a cross-sectional study

BMC Nephrology ◽

10.1186/1471-2369-14-39 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 16

Author(s):

Abeer Yasin ◽

Daisy Liu ◽

Luan Chau ◽

Joaquín Madrenas ◽

Guido Filler

Keyword(s):

Chronic Kidney Disease ◽

Growth Factor ◽

Calcium Phosphate ◽

Kidney Disease ◽

Fibroblast Growth Factor 23 ◽

Cross Sectional Study ◽

Fibroblast Growth ◽

Sectional Study ◽

Cross Sectional ◽

Phosphate Product

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MO797JUXTAPOSING THE EFFICACIES BETWEEN IRON-BASED AND NON-CALCIUM PHOSPHATE BINDERS FOR IMPROVING MINERAL AND BONE DISORDER PARAMETERS IN DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab096.006 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Boby Pratama Putra ◽

Felix Nugraha Putra

Keyword(s):

Chronic Kidney Disease ◽

Calcium Phosphate ◽

Kidney Disease ◽

Serum Phosphate ◽

Ferric Citrate ◽

Phosphate Binders ◽

Mineral And Bone Disorder ◽

Randomized Controlled ◽

Bone Disorder ◽

Iron Based

Abstract Background and Aims Hyperphosphatemia is a serious complication in chronic kidney disease (CKD) patients that serves as the main risk factor of CKD–mineral and bone disorder (CKD-MBD) progression. Previous studies suggested that iron-based phosphate binder showed better improvement in CKD-MBD parameters although the results were still inconclusive. This study aims to juxtapose the efficacies between iron-based and non-calcium phosphate binders for improving CKD-MBD parameters in dialysis-dependent (DD)-CKD patients. Method We did comprehensive searching to screen all relevant literature until November 2020 in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library. We included all randomized controlled trials (RCTs) accessing the efficacies of iron-based phosphate binders (sucroferric oxyhydroxide, ferric citrate) in improving CKD-MBD parameters compared with non-calcium phosphate binders (sevelamer) in DD-CKD patients. The parameters compared in this study are changes in serum phosphate (P), serum calcium ions (Ca), fibroblast growth factors-23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (calcidiol), and 1,25-dihydroxyvitamin D (calcitriol). Bias risk was accessed by using the revised Cochrane Risk-of-bias (RoB-2) tool. Analysis was performed to provide standard mean difference (SMD) with 95% confidence interval (CI) using random-effect heterogeneity test. Results Ten RCTs with total of 1,139 participants were included in this analysis. The sucroferric oxyhydroxide decreases FGF23 although not statistically significant (SMD = 0.22. 95% CI = -0.49 to 0.05, p = 0.11, I2 = 52%), but ferric citrate (SMD = -0.92. 95%CI = -1.56 to -0.29, p = 0.004, I2 = 69%) and the overall estimate (SMD = -0.45. 95% CI = -0.82 to -0.09, p = 0.02, I2 = 79%) showed significant FGF23 decline compared with sevelamer. The sucroferric oxyhydroxide showed no significant improvement of calcidiol (SMD = 0.08. 95%CI = -0.02 to 0.17, p = 0.13, I2 = 0%) and calcitriol (SMD = 0.02. 95% CI = -0.08 to 0.12, p = 0.74, I2 = 0%) compared with selevamer. There is also no significant improvement of iPTH in sucroferric oxyhydroxide subgroup (SMD = -0.14. 95%CI = -0.43 to 0.14, p = 0.32, I2 = 85%), ferric citrate subgroup (SMD = -0.02. 95%CI = -0.16 to 0.12, p = 0.80, I2 = 0%), and pooled group analysis (SMD = -0.10. 95%CI = -0.27 to 0.07, p = 0.27, I2 = 75%). Besides, this study also suggests no significant improvement comparison of serum P (SMD = -0.09. 95%CI = -0.19 to 0.02, p = 0.12, I2 = 38%) and Ca (SMD = 0.04. 95%CI = -0.12 to 0.20, p = 0.61, I2 = 57%). Conclusion There is no significant efficacies differences between iron-based and non-calcium phosphate binders for improving serum phosphate, serum calcium ions, iPTH, calcidiol, and calcitriol in dialysis-dependent chronic kidney disease patients, except for the FGF-23 parameter. However, further trials are needed to establish the juxtaposition.

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