Introduction:
Majority of Chronic kidney disease (CKD) patients are at an increased risk of developing disturbances of bone and mineral metabolism. These disturbances lead to a constellation of bone lesions which was previously referred to as renal osteodystrophy (ROD), manifesting as bone pain, muscle-tendon rupture, pruritus and high incidence of fractures. Patients with ROD are also predisposed to cardiovascular calcification with associated high morbidity and mortality rates.
The term ROD does not encompass this important extraskeletal manifestation. Therefore, to address these drawbacks and accommodate the extraskeletal manifestations,The KDIGO workgroup recommended a broader term, CKD–mineral and bone disorder (CKD-MBD) for the systemic disorder of mineral and bone metabolism due to CKD and that the term renal osteodystrophy should exclusively be used to describe disorders in bone morphology associated with CKD
CKD-MBD should be defined as:
A systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following:
(i) abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism;
(ii) abnormalities in bone turnover, mineralization, volume, linear growth, or strength; or
(iii) vascular or other soft tissue calcification
Several observational studies have shown an association between deranged markers of CKD-MBD and poor clinical outcomes in both predialysis and dialysis patients. For example, elevated levels of phosphate, calcium and PTH have been shown to be associated with cardiovascular-specific mortality in patients with CKD.
Methods:
AIM:
TO STUDY THE PROFILE OF MINERAL BONE DISORDERS IN MAINTENANCE HEMODIALYSIS PATIENTS
OBJECTIVES :
· TO EVALUATE THE DISTURBANCES IN MINERAL METABOLISM
· ABNORMALITIES OF BONE
· HORMONE ABNORMALITIES
PATIENTS & METHODS
• STUDY DESIGN –OBSERVATIONAL STUDY
• SETTING- TERTIARY CARE TEACHING INSTITUTE
STUDY POPULATION
ALL THE PATIENTS ADMITTED TO DEPARTMENT OF NEPHROLOGY – CHRONIC KIDNEY DISEASES ON MAINTENANCE HEMODILAYSIS , NAÏVE & OLD.
INCLUSION CRITERIA
• AGE > 18YEARS
• ON MAINTENANCE HEMODIALYSIS
• SYMPTOMATIC PATIENTS
EXCLUSION CRITERIA
• AGE < 18YEARS
• OTHER STAGES OF CHRONIC KIDNEY DISEASE
• ACUTE KIDNEY INJURY
• USE OF STERIODS
METHODOLOGY
• DEATILED HISTORY – ONSET OF SYMPTOMS
• DEMOGRAPHIC PROFILE
• BIOCHEMICAL PROFILE- CBP/RFT/SE/ALP/CA/PO4/UA
• VIT D3, i PTH ASSAY
• USG NECK
• SKELETAL SURVEY
Categories definition
• Hypocalcemia (corrected Ca< 8.5mg/dL), Hypercalcemia (corrected Ca>10.5 mg/dL),
• Hyperphosphatemia (PO4 >4.5 mg/dL), Hypophosphatemia (PO4 <2.5mg/dL),
• Vitamin D -Deficiency (<10ng/mL), Insufficiency (10- 20 ng/mL) and Sufficiency (>20ng/mL)
• Hyperparathyroidism was defined as iPTH levels of > 300 pg/ml.
• Adynamic bone disease in CKD 4 and 5 was defined as iPTH <100pg/Ml
• National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4 Suppl 3):
S1-201.
Results:
USG NECK
findings no of patients %
SKELETAL SURVEY
Conclusions:
· iPTH correlates significantly with Calcium, Phosphorous, Uric Acid, Alkaline phosphatase.
· Ultrasonography abnormalities of parathyroid gland are noted in 29.6%of the study group.
· Renal osteodystrophy was noted in 73.3% of the study population , of which Brown tumor was observed in 0.7%.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.