Prevalence of bone mineral metabolism alterations associated with chronic kidney disease not on dialysis
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Keywords

Renal insufficiency chronic
hyperparathyroidism
secondary
vitamin D deficiency.

How to Cite

1.
Luján Ramos MA, Ramírez Arce JA, Acevedo Romero JM, Gómez Jiménez S, Cañas Osorio JM, Santander Bohorquez D, Ustariz Durán JM, Rodelo Ceballo J. Prevalence of bone mineral metabolism alterations associated with chronic kidney disease not on dialysis. Rev. Colomb. Nefrol. [Internet]. 2019 Mar. 1 [cited 2024 Jul. 15];6(1):17-25. Available from: https://revistanefrologia.org/index.php/rcn/article/view/311

Abstract

Background: chronic kidney disease (CKD) is a public health problem, and bone mineral metabolism disorder is one of its main complications that directly contributes to morbidity and mortality. Several previous studies have shown an increase in its prevalence as the glomerular filtration rate (GFR) decreases, however, we do not have data from our country or Latin America.

Methods: We conducted a unicentric cross-sectional study in a nephrology consultation service in adults with CKD G1 to 5 who were not in renal replacement therapy, evaluated between January 2014 and March 2015. Data collection was performed with an instrument predefined that included demographic data, alterations of the mineral and bone metabolism parameters, and their management.

Results: 2026 patients were included, of whom 1756 had parathyroid hormone measurement, the average age was 74 years, 62% were women. The distribution by degrees of CKD was: G1: 4.9%, G2: 22.8%, G3: 57.4%, G4: 12.5% and G5: 2.4%. The main causes were hypertensive and diabetic nephropathy. We found vitamin D deficiency in 78.16%, secondary hyperparathyroidism in 63.67% and hyperphosphatemia in 12.38%, with an increase in prevalence as GFR worsened.

Conclusions: We found that mineral and bone metabolism alterations are frequent in patients with chronic kidney disease and start from early stages, as has been demonstrated in other studies. We believe that these results will lead to new management investigations in patients with CKD.

https://doi.org/10.22265/acnef.6.1.311
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References

1. Martínez-Castelao A, Górriz-Teruel JL, Bover-Sanjuán J, Segura-de la Morena J, Cebollada J, Escalada J, et al. Documento de consenso para la detección y manejo de la enfermedad renal crónica. Nefrología. 2014; 34(2):243-62.

2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;2(113):S1-130.

3. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013;382(9888):260-72. https://doi.org/10.1016S0140-6736(13)60687-X

4. Sociedad Colombiana de Nefrología e Hipertensión. Registro colombiano de diálisis y trasplante. 2007.

5. Fondo Colombiano de Enfermedades de Alto Costo. Enfermedad renal crónica, hipertensión arterial y diabetes mellitus. 2015;152. From: https://cuentadealtocosto.org/site/images/Situación_de_la_Enfermedad_Renal_Crónica_en_Colombia_2015.pdf

6. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF, et al. Chronic kidney disease and cardiovascular risk: Epidemiology, mechanisms, and prevention. Lancet. 2013;382(9889):339-52. https://doi.org/10.1016/S0140-6736(13)60595-4

7. Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M. Chronic Kidney Disease and Mortality Risk: A Systematic Review. J Am Soc Nephrol. 2006;17(7):2034-47. https://doi.org/10.1681/ASN.2005101085

8. Eknoyan G, Levin A, Levin NW. Bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4):1-201.

9. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl.2009;2(113):S1-130.

10. Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: Pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol. 2011;6(4):913-21. https://doi.org/10.2215/CJN.06040710

11. Mac Way F, Lessard M, Lafage-Proust MH. Pathophysiology of chronic kidney disease-mineral and bone disorder. Jt Bone Spine. 2012;79(6):544-9. https://doi.org/10.1016/j.jbspin.2012.09.014

12. Shirley DG, Unwin RB. Renal physiology. Comprehensive clinical nephrology. 4th edition. Floege J, Johnson RJ, Feehally J. Elseviers Saunders, St Louis, 2010.

13. Mejía N, Roman-García P, Miar AB, Tavira B, Cannata-Andía JB. El complejo escenario de las alteraciones de metabolismo óseo y mineral en la enfermedad renal crónica. Nefrologa. 2011;31(5): 514-9. https://doi.org/10.3265/Nefrologia.pre2011.Jun.10926

14. Hruska KA, Seifert M, Sugatani T. Pathophysiology of the chronic kidney disease - Mineral bone disorder. Curr Opin Nephrol Hypertens. 2015;24(4):303-9. https://doi.org/10.1097/MNH.0000000000000132

15. Martin KJ, Gonzalez EA. Metabolic Bone Disease in Chronic Kidney Disease. J Am Soc Nephrol. 2007;18(3):875-85. https://doi.org/10.1681/ASN.2006070771

16. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208-18. https://doi.org 10.1097/01.ASN.0000133041.27682.A2

17. Anderson JL, Vanwoerkom RC, Horne BD, Bair TL, May HT, Lappé DL, et al. Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: Dependent or independent risk factors? Am Heart J. 2011;162(2):331-339.e2. https://doi.org/10.1016/ j.ahj.2011.05.005

18. Aly Z Al, González EA, Martin KJ, Gellens ME. Achieving K/DOQI laboratory target values for bone and mineral metabolism: An uphill battle. Am J Nephrol. 2004;24(4):422-6. https://doi.org/10.1159 000080087

19. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease. Kidney Int. 2007;71(1):31-8. https://doi.org/10.1038/sj.ki.5002009

20. Górriz JL, Molina P, Bover J, Barril G, Martín-de Francisco ÁL, Caravaca F, et al. Characteristics of bone mineral metabolism in patients with stage 3-5 chronic kidney disease not on dialysis: Results of the OSERCE study. Nefrologia. 2013;33(1):46-60.

21. Craver L, Marco MP, Martínez I, Rue M, Borràs M, Martín ML, et al. Mineral metabolism parameters throughout chronic kidney disease stages 1-5 - Achievement of K/DOQI target ranges. Nephrol Dial Transplant. 2007;22(4):1171-6. https://doi.org/10.1093/ ndt/gfl718

22. Vassalotti JA, Uribarri J, Chen SC, Li S, Wang C, Collins AJ, et al. Trends in Mineral Metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis. 2008;51(4 SUPPL. 2):1999-2004. https://doi.org/10.1053/j.ajkd.2007.12.018

23. Hoy T, Fisher M, Barber B, Borker R, Stolshek B, Goodman W. Adherence to K/DOQI practice guidelines for bone metabolism and disease. Am J Manag Care. 2007 Nov;13(11):620-5.

24. Ramos AM, Albalate M, Vazquez S, Caramelo C, Egido J, Ortiz A. Hyperphosphatemia and hyperparathyroidism in incident chronic kidney disease patients. Kidney Int Suppl. 2008 Dec;(111):S88-93. https://doi.org/10.1038/ki.2008.543

25. Kestenbaum B, Katz R, De Boer I, Hoofnagle A, Sarnak MJ, Shlipak MG, et al. Vitamin D, parathyroid hormone, and cardiovascular events among older adults. J Am Coll Cardiol. 2011;58(14):1433-41. https://doi.org/10.1016/j.jacc.2011.03.069

26. Covic A, Kothawala P, Bernal M, Robbins S, Chalian A, Goldsmith D. Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol Dial Transplant. 2009;24(5):1506-23. https://doi.org/10.1093/ndt/gfn613

27. Durazo-Arvizu R a, Dawson-Hughes B, Sempos CT, Yetley E a, Looker AC, Cao G, et al. Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older. J Nutr. 2010;140(3):595-9. https://doi.org/10.3945/jn.109.116681

28. Mahmoodi BK. Comparison of Risk Prediction Using the CKD-EPI Equation and the MDRD Study Equation for Estimated Glomerular Filtration Rate. JAMA J Am Med Assoc. 2012;307(18):1941. https://doi.org/10.1001/jama.2012.3954.
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