Do bone mineral metabolism parameters in chronic kidney disease(CKD) patients meet KDOQI guidelines ? A tertiary care hospital based cross-sectional study

Abstract

Background: Chronic kidney disease (CKD) is now a public health problem with a high prevalence in Pakistan. However, there has been very little research on the profile of chronic kidney disease-related bone mineral disorders (CKD-MBD) in Pakistan. We thus aimed to assess the bone-mineral metabolism parameters in patients with CKD who are being followed at the Ziauddin University Hospital (a tertiary care hospital) in the southern city of Karachi, Pakistan. Methods: A hospital based cross-sectional study was conducted on 101 patients. The following clinical and biochemical data was collected: age, gender, serum creatinine and stage of CKD, serum PTH, calcium, albumin, phosphorus and Vitamin D levels- all at the same point in time. Results: The percentages of patients with serum levels within the recommended KDOQI guidelines for stages 3, 4 and 5 were as follows: serum PTH: 11.1, 31.8, 25.8, serum corrected calcium: 88.8,31.8, 42.9, phosphate 66.6, 50.0, 57.1, respectively. A significant number of patients were found to have secondary hyperparathyroidism as per the KDOQI criteria. 25-OH Vitamin D deficiency was also noted, as was hypocalcemia especially in CKD stage 5. However, our study demonstrated optimal control of serum phosphate levels for the majority of patients. Conclusion: This study highlights the difficulty of achieving KDOQI recommended serum PTH levels, and the need for raising awareness for more aggressive management of bone mineral metabolism parameters in order to decrease the morbidity and mortality associated with this disorder. Key Words: KDOQI, Chronic Kidney Disease (CKD), PTH, calcium, phosphorus