World Journal of
Pharmaceutical and Life Sciences

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An International Peer Reviewed Journal for Pharmaceutical and Life Sciences
An Official Publication of Society for Advance Healthcare Research (Reg. No. : 01/01/01/31674/16)
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Abstract

PREVALENCE AND SEVERITY OF DISORDERED MINERAL METABOLISM IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3-5(D). A STUDY FROM A TERTIARY CARE HOSPITAL OF BANGLADESH

*Prof. Dr. Nazneen Mahmood, Prof. M. M. Rahman, Dr. MMR Siddiqui, Prof. Zakia Sultana Shahid and Dr. SI Shumi

ABSTRACT

Chronic kidney disease (CKD) constitutes a public health problem that is estimated to affect more than 10% of the global population, and the prevalence of which has increased in recent years.Bone mineral metabolism abnormalities, which the KDIGO guidelines recently defined as CKD-mineral bone disorder (CKD-MBD), have been clearly implicated not only in the development of secondary hyperparathyroidism (SHPT) and renal osteodystrophy but have also been associated with the progression of CKD and its complications, including cardiovascular complications and they ultimately contribute significantly to an increase in morbidity and mortality rates among patients with CKD. However, despite high prevalence of MBDs in CKD patients, there are no data on CKD-MBD from Bangladesh. This was a prospective, observational study carried over a period of 1 year(January 2016- December 2016) in Anwer Khan Modern Medical College Hospital. The study population included newly diagnosed CKD Stage 3-5 and prevalent CKD Stage 5D(Dialysis) adult patients of 18 years and above.The biochemical markers of CKD-MBD, namely calcium, phosphate, intact parathyroid hormone(iPTH) and 25-hydroxyvitamin Vitamin D3(250HD) were measured.115 (48 males and 67 females) patients were included in the study with a M:F of 1:1.4. Mean age was 60.07±11.41 years (Range 18-90 years). The most common causes of underlying native kidney diseases were Diabetic nephropathy (31.30%) followed by Hypertension (27.80%), Chronic glomerulonephritis (24.30%), Chronic interstitial nephritis (11.30%) and Autosomal dominant poly cystic kidney disease (5.20%). 44.35%(51) patients were from stage 3 CKD and 32.17%(37), 13.05%(15), 10.43%(12) were from stage 4, stage 5 and stage 5(D) respectively. Out of 51 patients of stage 3 CKD, 82.35% were of Hyperparathyroidism, 9.8% of Hypoparathyroidism and 7.85% were of target range parathormone. Among stage 4 CKD patients (37) of the study group 78.37% were of Hyperparathyroidism and 8.10% and 13.53% were of Hypoparathyroidism Target range respectively. Out of 27 patients of stage 5 and 5(D) CKD, 44.44%, 18.52% and 37.04% were of Hyperparathyroidism, Hypoparathyroidism and Target range. So it is observed that most of the patients (82.35%) of stage 3 CKD presents with Hyperparathyroidism. The mean PTH level of the patient of CKD stage 3,4,5 and 5(D) are 167.70 ±120.79, 235.35±256.08, 292.02±70.34 and 579.31±77.01 respectively. The mean PTH of the patients of stage 5(D) is more among all stages. 97 of all patients were of Hypercalcaemia and 39 of the patients had Hyperphosphataemia, 43 patients had mild Vit D deficiency, 53 had insufficiency and none of them had severe Vit D deficiency. Mean values of serum levels of corrected Calcium(cCa), Phosphate(PO4), creatinine, 25-OHD, intact Parathormone(i PTH) and Albumin are 8±1.06 mg/dl, 4.38±0.89 mg/dl, 3.49±2.6 mg/dl, 20.66±10.05 nmol/L, 318.59±131.05 pg/ml and 24.55±3.13gm/L respectively. There was a high prevalence of CKD-MBD in Bangladeshi CKD patients. CKD-MBD is more common and more severe and has an early onset as compared to the western population.

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