Valson A T, Sundaram M, David V G, Deborah M N, Varughese S, Basu G, Mohapatra A, Alexander S, Jose J, Roshan J, Simon B, Rebekah G, Tamilarasi V, Jacob C K
Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Department of Cardiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Indian J Nephrol. 2014 Mar;24(2):97-107. doi: 10.4103/0971-4065.127897.
Chronic kidney disease related-mineral bone disorder (CKD-MBD) has been poorly studied in pre-dialysis Indian CKD patients. We aimed to study the clinical, biochemical and extra skeletal manifestations of untreated CKD-MBD in pre-dialysis Stage 4 and 5 CKD patients attending nephrology out-patient clinic at a tertiary care hospital in South India. A hospital based cross-sectional survey including, demographic profile, history of CKD-MBD symptoms, measurement of serum calcium, phosphate, parathyroid hormone, 25 hydroxy vitamin D (25(OH) D) and alkaline phosphatase; lateral abdominal X-rays for abdominal aortic calcification (AAC) and echocardiography for valvular calcification (VC) was carried out. Of the 710 patients surveyed, 45% had no CKD-MBD related symptom. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism (>150 pg/mL) and 25(OH) D levels <30 ng/mL was 66.3%, 59%, 89.3% and 74.7% respectively. Echocardiography was carried out in 471 patients; 96% of whom had VC (calcification score ≥1). Patients with VC were older and had lower 25(OH) D levels than those without. Lateral abdominal X-rays were obtained in 558 patients, 6.8% of whom were found to have AAC, which was associated with older age. Indian patients with incident CKD-MBD have a high prevalence of hypocalcemia, 25(OH) D deficiency and VC even prior to initiating dialysis while AAC does not appear to be common. The association between 25(OH) D deficiency and VC needs further exploration.
慢性肾脏病相关矿物质骨病（CKD-MBD）在印度透析前慢性肾脏病患者中的研究较少。我们旨在研究印度南部一家三级护理医院肾病门诊中未接受治疗的4期和5期透析前慢性肾脏病患者CKD-MBD的临床、生化和骨骼外表现。进行了一项基于医院的横断面调查，包括人口统计学资料、CKD-MBD症状史、血清钙、磷、甲状旁腺激素、25羟维生素D（25(OH)D）和碱性磷酸酶的测定；进行腹部侧位X线检查以评估腹主动脉钙化（AAC），并进行超声心动图检查以评估瓣膜钙化（VC）。在接受调查的710名患者中，45%没有CKD-MBD相关症状。低钙血症、高磷血症、甲状旁腺功能亢进（>150 pg/mL）和25(OH)D水平<30 ng/mL的患病率分别为66.3%、59%、89.3%和74.7%。对471名患者进行了超声心动图检查；其中96%有VC（钙化评分≥1）。有VC的患者比没有VC的患者年龄更大，25(OH)D水平更低。对558名患者进行了腹部侧位X线检查，其中6.8%被发现有AAC，这与年龄较大有关。印度新发CKD-MBD患者在开始透析前就有很高的低钙血症、25(OH)D缺乏和VC患病率，而AAC似乎并不常见。25(OH)D缺乏与VC之间的关联需要进一步探索。
