Spectrum of Chronic Kidney Disease-Mineral Bone Disorders in Newly Detected Advanced Renal Failure Elderly Patients (CKD Stage 4 and 5)

ABSTRACT

Introduction: CKD MBD remains a complex issue in elderlypatients that has yet to be clearly defined. We aimed to evaluatethe disturbances in mineral bone disease in newly detected,untreated stage 4 and 5 elderly chronic kidney disease patients.Material and Methods: A cross-sectional observational studywith total of 93 newly detected patients underwent clinicalevaluation, biochemical assessment [serum albumin, calcium,intact parathyroid hormone(iPTH), 25- hydroxyvitamin D,phosphorus, alkaline phosphatase(ALP), creatinine], BMDmeasurement by dual-energy X-ray absorptiometry(DXA)and Lateral Abdominal X ray for aortic calcification(AAC).Results: Symptoms related to CKD-mineral bone disorderwere seen in 33.6% of the study patients. Prevalence ofhypocalcemia, hyperphosphatemia, hyperparathyroidism,and hypovitaminosis D were 64.2%, 81.1%, 49.5%,and 89.5%, respectively. Prevalence and severity ofhyperphosphatemia, hyperparathyroidism, hypocalcemia andraised ALP increases from stage 4 to stage 5 CKD, whilehypovaitaminosis D is equally prevalent in both stages.Secondary hyperparathyroidism is most common form ofCKD MBD in untreated elderly CKD population. BMD byDXA showed a low bone mass in 26.81% of our patients atdistal forearm. Patients older than 75 years more commonlyhad osteoporosis, lower ALP, phosphorus and iPTH. AAC wasseen in 13.98% of study group. Patients with AAC had higherphosphorus, iPTH and ALP. Compared to non diabetic CKDpatients, lower levels of phosphorus, ALP and iPTH wereobserved in diabetic CKD patients.Conclusion: Our study shows CKD MBD is prevalent inelderly population where symptoms alone are not enough todiagnose the bone disease.