Department of Medicine, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India.
Ren Fail. 2013 Sep;35(8):1105-11. doi: 10.3109/0886022X.2013.815102. Epub 2013 Jul 23.
There is limited data available especially in Indian Population about prevalence of reduced bone mineral density (BMD) and various factors associated with it in CKD patients not on dialysis.
This study included 75 adult patients. Patients were divided into three groups depending upon GFR. Serum creatinine, albumin, calcium, phosphate (PO4), alkaline phosphatase, iPTH and Vitamin D were measured at baseline. BMD was measured by dual energy X-ray absorptiometry.
There were 51 male and 24 female patients. The mean serum phosphate, alkaline phosphatase and iPTH levels increased steadily as CKD progressed. On the other hand, mean corrected serum calcium and Vitamin D levels decreased progressively in group A, B and C. The mean serum PTH values in group A, B and C were 137.16 ± 109.85, 265.02 ± 132.03 and 328.14 ± 119.23 pg/mL, respectively and there was significant increase in mean PTH level from group A to group C (p < 0.05). The mean level of vitamin D showed a trend of declination from group A to C (p < 0.05). Z-score for group A, group B and group C was 1.11 ± 2.39, 0.87 ± 2.66 and -0.92 ± 1.59, respectively. Similarly, T score for the three groups were 0.47 ± 2.34, -0.4 ± 2.00 and -1.524 ± 1.42. Both T-score and Z-score positively correlated with GFR. There was negative correlation between Z-score and iPTH, and positive correlation with Vitamin D.
Reduced bone density was seen early in the course of CKD as estimated from reduced BMD levels, increased prevalence of osteoporosis and increased fracture risk and it worsened with the progression of CKD.
在未接受透析的 CKD 患者中，关于骨密度（BMD）降低的患病率以及与之相关的各种因素，特别是在印度人群中，可用的数据有限。
本研究纳入了 75 名成年患者。根据肾小球滤过率（GFR）将患者分为三组。在基线时测量血清肌酐、白蛋白、钙、磷（PO4）、碱性磷酸酶、iPTH 和维生素 D。使用双能 X 射线吸收法测量 BMD。
患者中 51 名男性和 24 名女性。随着 CKD 的进展，血清磷酸盐、碱性磷酸酶和 iPTH 水平稳步升高。另一方面，A、B 和 C 组的校正血清钙和维生素 D 水平逐渐降低。A、B 和 C 组的平均血清 PTH 值分别为 137.16±109.85、265.02±132.03 和 328.14±119.23 pg/mL，PTH 水平从 A 组到 C 组显著升高（p<0.05）。维生素 D 水平呈从 A 组到 C 组下降的趋势（p<0.05）。A、B 和 C 组的 Z 评分分别为 1.11±2.39、0.87±2.66 和-0.92±1.59。同样，三组的 T 评分分别为 0.47±2.34、-0.4±2.00 和-1.524±1.42。T 评分和 Z 评分均与 GFR 呈正相关。Z 评分与 iPTH 呈负相关，与维生素 D 呈正相关。
从 BMD 水平降低、骨质疏松症患病率增加和骨折风险增加估计，在 CKD 早期就存在骨密度降低，并且随着 CKD 的进展而恶化。
