“ Clinical pattern of bone mineral derangements , if any ( High bone turnover disease / Low bone turnover disease ) in CKD Patients undergoing Haemodialysis ”

Chronic kidney disease related mineral and bone disease (CKD-MBD) is a worldwide challenge in haemodialysis patients associated with high morbidity and mortality. CKD-MBD, the new terminology used for Renal Osteodystrophy and Renal bone disease (KDIGO).In clinical practice, bone biopsy is used infrequently to detect MBD in CKD, because it is an invasive and often expensive procedure and the samples obtained require specialized processing that is not widely available. Instead iPTH levels can be highly sensitive and it is one of the useful noninvasive biochemical parameters to detect MBD in CKD. Therefore, the present study was carried out to detect Pattern of CKDMBD by non-invasive biochemical method of serum intact parathyroid hormone (iPTH) estimation in CKD patients who have been on haemodialysis for ≥ 5 months. This study was a cross-sectional observational study. The study population of 330 patients (>18 years) on maintenance haemodialysis coming to Dialysis Unit of Department of Medicine over a period of three years were enrolled in the study. Each patient was considered only once for the study. Also biochemical analysis of serum iPTH, corrected calcium, phosphorus and tALP, of all cases were done using fully automated equipments.Patients were divided into three groups ie. High Bone Turn Over (PTH value > 300pg/ml), Low Bone Turn Over (PTH value < 100pg/ml) and a group with apparently Normal Bone (based on 100-300 pg/ml intact PTH values). All statistical analyses were performed using SPSS statistical software, version 17. Chi square, ANOVA with Post-Hoc Tukey HSD and Coefficient tests were used. The control of CKD-MBD was assessed in the backdrop of the KDIGO guidelines. In the present study Nineteen patients were complained with bone pain and almost five patients were had bone fracture. MBD presents itself in three forms in CKD patients undergoing Haemodialysis in the present study. In clinical pattern most common MBD was found in the present study High bone turn over (40.3%) followed by low bone turn over (33.5 %, iPTH<100 pg/mL) and normal bone turn over (26.2%).There were statistically significant association of serum iPTH, with Corrected Ca and P (p = 0.032 and p = 0.035, respectively) observed. The results of the present study revealed that bone pain was significantly associated with iPTH levels.( χ 2 =6.631 and P=0.036). The pattern of CKD-MBD is dominated by high bone turn-over disease in our centre. We have also demonstrated that disorders of mineral metabolism are associated with short-term effects, such as hospital admissions and muscleand skin and bone complaints. Short of a bone biopsy, biochemical tests such as an intact PTH can be used to evaluate bone disease because markedly high or low values do predict underlying bone turnover. Controlling PTH levels prevents damage to bones. PTH levels should be evaluated regularly in haemodialysis patients and awareness regarding PTH abnormalities should be there among the treating physicians also.