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Background: Recent guidelines for bone metabolism and disease in CKD recommend that, the target levels for calcium (Ca), phosphorus (P), calcium x phosphorus product(Ca × P) and parathyroid hormone (PTH) levels should be maintained at 8.8-10.2 mg/dl, 2.1-5.6 mg/dl, < 57.1mg2/dl2 and 8.7-79.6 pg/ml, respectively in patients of CKD.Methods: This was an observational study done in 70 patients, presenting in outpatient and inpatient department of tertiary care multi-specialty teaching hospital. Study was carried out at Dhiraj Hospital, Vadodara, Gujarat, in interval of one and half year.The study was investigation based, in the age group of 18 years and above who presented with chronic kidney disease. Serum Ca and serum P levels were measured by Fully Automated Colorimetry and Parathyroid hormone was measured by FLIA-fluoroscence linked immunoassay.Results: Among the 70 patients of chronic kidney disease, 55.7% showed abnormal calcium levels, 41.4% showed abnormal phosphorus levels,72.9% showed abnormal PTH levels,11.4% showed abnormal Ca x P levels.Conclusions: The correlation between the phosphorus and PTH was linear and statistically significant. But the correlation between calcium and PTH was statistically insignificant and between Ca x P and PTH was very weak and statistically insignificant in CKD patients.
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Objective To investigate the influencing factors of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Methods A total of 181 CKD patients undergoing multi-slice spiral computed tomography for coronary artery were selected. The patients were divided into four groups of CKD 1 stage, CKD 2-3 stage, CKD 4-5 stage and maintenance hemodialysis (MHD) according to the kidney disease outcome quality initiative (K/DOQI) guidelines established by the National Kidney Foundation. According to the CAC scores assessed using the Agatston scoring method, the patients were divided into non-CAC group (CAC score≤10), mild CAC group (CAC score 11-100), moderate CAC group (CAC score 101-400), and severe CAC group (CAC score>400). The related factors and independent influencing factors of CAC in CKD patients were analyzed by Spearman linear regression analysis and multivariate Cox regression analysis, respectively. Results Of the 181 patients, 44 were CKD 1, 36 were CKD 2-3, 25 were CKD 4-5, and 76 were MHD. The incidence of CAC in the CKD patients and MHD patients was 55.3% (100/181) and 80.3% (61/76), respectively. The CAC score of CKD patients was significantly increased with the aggravation of renal impairment (r＝0.526, P0.05). Multivariate Cox regression analysis showed that age, eGFR, serum phosphorus, calcium-phosphorus product and serum FGF23 level were the independent influencing factors of CAC in CKD patients (OR [95% CI]: 3.723 [2.521-8.363], 0.582 [0.415-0.724], 5.252 [0.415-0.724], 11.243 [10.185-16.836], and 2.469 [1.141-5.362]). Conclusion Age, eGFR, serum phosphorus, calciumphosphorus product and serum FGF23 level are independent influencing factors of CAC in CKD patients.
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La enfermedad renal crónica (ERC) es un problema de salud pública y su incidencia aumenta con el crecimiento y envejecimiento de la población. Los pacientes en diálisis tienen una alta mortalidad en comparación con la población general y las causas cardiovasculares prevalecen contribuyendo para ello múltiples factores de riesgo como anemia, inflamación crónica y la elevación del producto de calcio/fósforo (PCa). Se realizó un estudio observacional, descriptivo y transversal en 72 pacientes con ERC en hemodiálisis, ambos géneros y edades entre 18-80 años. Se realizó historia clínica y procesamiento de hematología y química sanguínea. Se calculó el calcio corregido a aquellos con albumina <4g/dL y se determinó el PCa. El análisis estadístico se realizó mediante el programa SPSS15.0. Los resultados se expresaron en valores absolutos, relativos y/o como Media ± Desviación Estándar y para correlaciones se utilizó el coeficiente de Correlación de Pearson, tomando como significativo un valor de p<0.05. El 83,3% fueron hombres de 52±13,6 años. La hipertensión y la diabetes fueron las principales causas de ERC con 25% y 20,8%, respectivamente. Los niveles séricos de fosforo 7,7mg/dL y calcio 9,12mg/dL y el PCa fueron de 71,80mg2/dL. La PCRus fue de 13,44±7,31mg/L. El índice de Pearson entre PCa y PCRus p=0,126, así como también al correlacionar la PCRus con el fosforo (p=0,237). Pero, al determinar la relación lineal entre el calcio y la PCRus se obtuvo un coeficiente negativo (p=0,001) al igual que con los valores de hemoglobina (p=0,007). No se encontró una relación directa ni significativa entre los niveles de PCRus y el PCa, Fosforo, Fosfatasa Alcalina ni Albumina se evidenció una relación negativa y significativa con las concentraciones de calcio y hemoglobina...
Chronic kidney disease (CKD) is a public health problem and its incidence increases with aging. It is known that dialysis patients have a high mortality compared with the general population and prevalent cardiovascular causes contributing to it multiple risk factors such as anemia, chronic inflammation and rising product of calcium/phosphorus (PCa). An observational, descriptive, cross-sectional study in 72 CKD patients on hemodialysis, both genderss and ages between 18-80 years. A clinical history and processing of hematology and blood chemistry were done. Seric calcium was corrected in those those with albumin <4g/dl. PCa was measured. Statistical analysis was performed using SPSS 15.0 software. The results were expressed in absolute, relative and/or as mean ± standard deviation. The Pearson correlation coefficient was used, significant if p <0.05. 83.3% were males aged 52±13.6 years. Hypertension and diabetes were the main causes of CKD with 25% and 20.8% respectively. Serum phosphorous was 7.7mg/dL and calcium . 12 mg/dL, and the PCa was 71.80 mg2/dL. The HSCRP was 13.44 ± 7.31 mg/L. Pearson index was used between PCa and HS-CRP p=0.126, as well as to correlate with phosphorus p=0.237. To determine the linear relationship between calcium and HS-CRP with a negative coefficient p=0.001 as with hemoglobin values p=0.007 was obtained. A direct and significant relationship between levels of HS-CRP and PCa, phosphorus, alkaline phosphatase and albumin had a significant negative relationship with calcium concentrations (p=0.001) and hemoglobin (p=0.007) was evidenced...
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Humanos , Masculino , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Diálise Renal/métodos , Doenças Cardiovasculares/patologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Proteína C-Reativa/uso terapêutico , Nefrologia , Saúde PúblicaRESUMO
Objective To observe the effect of different calcium concentration peritoneal dialysate on calcium-phosphorus metabohsm in uremia patients under peritoneal dialysis. Methods Forty uremia patients who the first entered peritoneal dialysis were divided into two groups: standard calcium concentration group (20 cases), low calcium concentration group (20 cases). Treated with continuous ambulatory peritoneal dialysis (CAPD), combining with oral calcium carbonate, observing 12 months. Results When the first entering CAPD, serum calcium, phosphorus, calcium-phosphorus product, immunoreactive parathyroid hormone (iPTH) of the two groups had no differences. Hyperphosphatemia, lower iPTH were universal. After 6 months' treatment, hypercalcemia and hyperphosphatemia in standard calcium concentration group got increasingly serious.While in low calcium concentration group, serum calcium, phosphorus, calcium-phosphorus product all decreased significantly, moreover, they were also lower than post-treatment standard calcium concentration group(P<0.01). In the following 6 months, in low calcium concentration group,serum calcium, calcium-phosphorus product maintained at the normal level serum phosphorus also decreased to the normal level iPTH maintained about 150 ng/L. During the treatment, all patients had no hypotension and hyperspasmia. Conclusion Low calcium concentration peritoneal dialysate can ameliorate disorder of calcium-phosphorus metabohsm, delay the appearance of its comphcations.