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The objectives of our study were to describe mineral and bone disorders in patients with chronic kidney disease (CKD) not yet at the dialysis stage and to assess the compliance of phosphocalcium balance indicators with international KDIGO recommendations.
This was a retrospective study conducted over a period of 10-months (01 November 2018 to 31 August 2019) in the nephrology and haemodialysis department of the Renaissance University Hospital in Ndjamena. We included all patients followed in the service for non-dialysis CKD, aged over 18 years and consenting to participate in this study.
A total of 387 patients files were collected, 82 of which were retained. The mean age of the patients was 52.7 (± 15.8) years, with a male predominance (67.1%). The comorbidities were arterial hypertension (71.9%) and diabetes (24.4%). CKD predominated in stage V (55%), followed by stage III (23%). Clinical signs were dominated by diffuse bone pain (37.8%), pruritus (8.5%), muscle pain (7.3%) and insomnia (8.5%). Disturbances in phosphocalcic metabolism were marked in stage IV (11.9% and 10.7%) and stage V (40.5% and 34.5%) for hypocalcaemia and hyperphosphataemia. Secondary hyperparathyroidism and 25 OH vitamin D deficiency were 28.8% and 40.5% in stage V CKD. Compliance with international KDIGO recommendations was 59.7%, 53.7% and 37% respectively for serum calcium, serum phosphorus and parathyroid hormone. Radiological fractures were noted in 4.9% of patients. Management was based on calcium carbonate (52.4%), native vitamin D (64.6%) and Cinacalcet (6.1%). Hypocalcaemia (p=0.005) and hyperphosphataemia (p=0.0001) predominated in stage V patients, with a significant difference.
The balance of mineral and bone disorders is far from being achieved for the majority of patients, due to lack of resources and the exorbitant cost of treatment. Prevention of mineral and bone disorders is a fundamental pillar of CKD treatment for our patients.