Prevalence of Mineral Bone Disease in Chronic Kidney Disease Patients using Biochemical Markers

Introduction: Chronic Kidney Disease (CKD), a condition characterised by a gradual loss of renal function over the time, has emerged as a major public health concern with 17% prevalence in Indian population. Decrease in renal function in CKD leads to progressive metabolic derangements of mineral and bone homeostasis which in turn makes them susceptible to bone related and cardiovascular complications. Aim: To calculate the prevalence of Mineral Bone Disease (MBD) in CKD patients by estimation of biochemical markers Calcium (Ca), Phosphorus (P), Alkaline Phosphatase (ALP) and intact Parathyroid Hormone (iPTH) and to analyse their prevalence across different stages of CKD. Materials and Methods: This was a hospital based cross-sectional study conducted at Medanta-the Medicity hospital in 2300 previously diagnosed CKD cases who visited the Nephrology OPD for their follow-up visits, from October 2017 to December 2018. Serum levels of Ca, P, ALP and iPTH were estimated in VITROS 4600 and ARCHITECT I system automated analysers using commercially available kits. Stagewise and overall prevalence of deranged levels of these markers was calculated and based on this the prevalence of MBD was calculated. Statistical analysis was done using SPSS version 24.0. Descriptive analysis of quantitative parameters was expressed as means and standard deviation. The analysis for comparison among three or more categories was done using one-way ANOVA. Categorical data was analysed using Chi square test for proportions and data was expressed as absolute number and percentage in a contingency table along with the chi square and p-values. The p-value <0.05 was considered statistically significant. Results: Prevalence of MBD in overall CKD patients was 81.6%; the stage-wise prevalence being 63.4% (stage 3), 76.9% (stage 4), 87.6% (stage 5) and 91.3% (stage 5D). The overall prevalence of hypocalcaemia, hyperphosphatemia, high ALP and secondary hyperparathyroidism was 27.8%, 48.3%, 26.5% and 75.6%, respectively. Conclusion: The present study reports an alarmingly high prevalence of MBD in CKD cases; the disease burden being maximum in stage 5 and 5D. This was despite the administration of relevant medications and supplements to prevent MBD. Thus, there needs to be some change in treatment protocol to reduce the prevalence of MBD to improve the quality of life and reduce mortality rate in CKD patients.