Nontraditional cardiovascular risk factors in hemodialysed patients with chronic kidney disease

Background. Chronic kidney disease is connected with bone metabolism disorders leading to renal osteodystrophy and increased cardiovascular morality and morbidity. The publication of the KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in CKD in 2003 recommended target levels for such parameters as: albumin-corrected calcium (Caalb), phosphorus (P), parathyroid hormone (iPTH) and calcium-phosphorus product (Ca x P). Objectives. The aim of the present study was to evaluate the achievement of target levels recommended by KDOQI Guidelines in hemodialysed patients. Material and methods. The study group consisted of 80 hemodialysed patients (W - 39%, M - 61%), mean age 61 +/- 13 years (range 19-85), mean duration of HD treatment 43 +/- 41 months. Ca, P and iPTH serum levels were measured and Caalb, Ca x P were calculated. Results. Mean serum Caalb and Ca x P were normal, both in men and women. Mean serum P and iPTH were higher than recommended in KDOQI guidelines. 58% of patients achieved recommended levels of Caalb and Ca x P but only 31% - P and 15% iPTH levels. There were 63% patients who had elevated levels of iPTH. Moreover 15% had iPTH levels over 1000 pg/ml that is connected with high bone turnover and serious bone metabolism disorders. Conclusions. 1. A large percentage of patients do not achieve KDOQI 2003 recommended serum levels of bone metabolism parameters, mainly P and iPTH. 2. Patients with abnormal levels of these parameters are especially exposed to renal osteodystrophy and increased cardiovascular morality and morbidity. 3. Proper treatment is needed to reduce untraditional and typical cardiovascular risk factors in this group of patients.