Etta Praveen Kumar, Sharma R K, Gupta Amit
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):874-885.
We aim to evaluate the disturbances in mineral metabolism, abnormalities in bone mineral density (BMD), and extraskeletal calcification in newly detected, untreated predialysis stage 4 and 5 chronic kidney disease (CKD) patients at a tertiary care hospital in North India. This is cross-sectional observational study. A total of 95 (68 males, 27 females) newly detected patients underwent clinical evaluation, biochemical assessment [serum calcium, phosphorus, alkaline phosphatase (ALP), albumin, creatinine, intact parathyroid hormone (iPTH), 25- hydroxyvitamin D (25(OH)D)], BMD measurement (at spine, hip, and forearm) by dual-energy X-ray absorptiometry (DXA), lateral abdominal radiograph [for abdominal aortic calcification (AAC)], skeletal survey (to look for any abnormality including fractures), and echocardiography [for any cardiac valvular calcification (CVC)]. Symptoms related to CKD-mineral bone disorder were seen in 33.6% of the study patients. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism, and hypovitaminosis D was 64.2%, 81.1%, 49.5%, and 89.5%, respectively. CVC was seen in 22.1% of patients on echocardiography, mostly involving the mitral valve. Patients with CVC were more likely to be males and smokers. There was no significant difference in iPTH levels between patients with or without CVC. AAC was seen in 10.5% of patients on lateral abdominal X-ray. Patients with AAC had higher levels of iPTH, phosphorus, and ALP and lower levels of calcium compared to patients without AAC. BMD by DXA showed a low bone mass in 41.05% of our patients and was more prevalent in CKD stage 5. Most of the study patients had hyperparathyroidism and low 25(OH)D levels. Our study shows that newly detected, naïve Indian CKD patients have a high prevalence of disturbances of mineral metabolism including hyperparathyroidism, Vitamin D deficiency, abnormal BMD, and valvular and vascular calcification, even before initiating dialysis.
我们旨在评估印度北部一家三级护理医院新诊断出的、未经治疗的透析前4期和5期慢性肾脏病（CKD）患者的矿物质代谢紊乱、骨密度（BMD）异常和骨骼外钙化情况。这是一项横断面观察性研究。共有95例（68例男性，27例女性）新诊断患者接受了临床评估、生化评估[血清钙、磷、碱性磷酸酶（ALP）、白蛋白、肌酐、完整甲状旁腺激素（iPTH）、25-羟维生素D（25(OH)D）]，通过双能X线吸收法（DXA）测量骨密度（在脊柱、髋部和前臂），进行腹部侧位X线检查[用于评估腹主动脉钙化（AAC）]、骨骼检查（以查找包括骨折在内的任何异常情况）以及超声心动图检查[用于评估任何心脏瓣膜钙化（CVC）]。33.6%的研究患者出现了与CKD-矿物质骨疾病相关的症状。低钙血症、高磷血症、甲状旁腺功能亢进和维生素D缺乏症的患病率分别为64.2%、81.1%、49.5%和89.5%。超声心动图检查发现22.1%的患者存在CVC，主要累及二尖瓣。患有CVC的患者更可能是男性且为吸烟者。有或无CVC的患者之间iPTH水平无显著差异。腹部侧位X线检查发现10.5%的患者存在AAC。与无AAC的患者相比，有AAC的患者iPTH、磷和ALP水平较高，而钙水平较低。DXA测量的骨密度显示41.05%的患者骨量较低，且在CKD 5期更为普遍。大多数研究患者患有甲状旁腺功能亢进且25(OH)D水平较低。我们的研究表明，新诊断出的、未接受过治疗的印度CKD患者即使在开始透析之前，矿物质代谢紊乱的患病率也很高，包括甲状旁腺功能亢进、维生素D缺乏、骨密度异常以及瓣膜和血管钙化。
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