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Chronic kidney disease – mineral and bone disorder (CKD-MBD) pattern has been shifting from secondary hyperparathyroidism towards adynamic bone disease (ABD) for the past few decades, more so in maintenance hemodialysis (MHD) patients. Assessing the spectrum of CKD-MBD in MHD patients in Bangladesh thus becomes necessary.
This cross-sectional study was performed in 3 HD centers across Bangladesh – Kidney Foundation, Dhaka, Sylhet and Pabna. Data was collected from 501 patients on HD for at least 3 months during May – June, 2023. Data was analyzed by statistical analysis software (SAS) studio.
Mean age of the patients was 51.5 (±13) years. 50% were female and 48.3% were diabetic. Mean duration of DM was 14.3 (±8.1) years. About 75% of all patients took twice-weekly HD, rest took thrice-weekly HD.
DM patients were significantly older compared to the non-DM patients (mean age 56.5 vs 47.2 years, p<0.0001) and were on HD for a shorter period (mean duration 19.1 vs 30.8 months, p<0.0001). HD frequency did not vary between DM and non-DM patients. Multivariate analysis showed that HD adequacy was significantly lower in DM patients compared to non-DM patients (single pool Kt/V 1.29 vs 1.43, p = 0.0003).
Among all patients, the mean serum calcium level was 2.5 (±0.3) mmol/L. 26.5% of the patients had hypercalcemia, 12.3% had hypocalcemia and 61.2% had normal calcium levels. In comparison, 18.2% of the patients had hypophosphatemia, whereas 62.1% had hyperphosphatemia and 19.6% had normal phosphate levels. The median intact parathyroid hormone (iPTH) level was 280.4 pg/ml. When a cutoff of 150 was applied to determine ABD adopted from prior literature, 158 (31.5%) patients fell below this level.
The triad of hypercalcemia, hypophosphatemia and iPTH < 150 pg/ml were all significantly higher in DM compared to non-DM patients. A multivariate linear regression model, controlling for single pool Kt/V showed that DM patients had about 98.1 pg/ml lower mean iPTH level compared to non-DM patients (p = 0.001).
Prevalence of hypercalcemia and low iPTH level, suggesting ABD was quite high in MHD patients. This effect was particularly pronounced in DM patients. Role of overtreatment without adequate biochemical follow-ups needs to be evaluated further.