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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2019  |  Volume : 30  |  Issue : 3  |  Page : 741-742
Biochemical profile of mineral and bone disorder in prevalent hemodialysis patients


1 Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
2 Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam; Department of Internal Medicine and Nephrology, King Fahd Hospital of the University, Alkhobar, Saudi Arabia

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Date of Submission09-Oct-2018
Date of Acceptance11-Oct-2018
Date of Web Publication26-Jun-2019
 

How to cite this article:
Alquraini FR, Alnazer RH, Albahrani OA, Alkhars R, Almueilo SH. Biochemical profile of mineral and bone disorder in prevalent hemodialysis patients. Saudi J Kidney Dis Transpl 2019;30:741-2

How to cite this URL:
Alquraini FR, Alnazer RH, Albahrani OA, Alkhars R, Almueilo SH. Biochemical profile of mineral and bone disorder in prevalent hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Jul 16];30:741-2. Available from: http://www.sjkdt.org/text.asp?2019/30/3/741/261364


To the Editor,

Chronic kidney disease-mineral and bone disorders (CKD-MBDs) are prevalent among maintenance hemodialysis (HD) patients. They are associated with vascular calcification and increased cardiovascular morbidity and morta-lity.[1] Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group guidelines for CKD-MBD have provided the target range of serum calcium, phosphate, and parathyroid hormone (PTH) values in the HD population.[2] It is often difficult to achieve all targets within the suggested range.[3] An increasing prevalence of elderly patients undergoing maintenance HD has been observed world-wide.[4] Data on mineral and bone status in elderly HD patients are scarce. Some reports have suggested that age is associated with a decrease in serum calcium, phosphorus, and PTH.[5]

In this cross-sectional study, the medical records of long-term HD patients were carefully reviewed for biochemical parameters related to CKD-MBD. The medical records of 87 patients, 50 (57.5%) of whom were males and 46 (52.9%) had diabetes mellitus (DM), were the subject of this analysis. Thirty-one patients (35.6%) were 60 years of age or older. DM was significantly more prevalent in the elderly group. Corrected serum calcium was significantly higher in elderly patients. On the other hand, hyperphosphatemia was more commonly observed in the younger group of patients. Intact PTH blood level was significantly lower in the elderly group. Alkaline phosphatase (ALP) blood level tended to be lower in elderly patients [Table 1].
Table 1: Chronic kidney disease-mineral and bone disorders parameters in hemodialysis patients according to age group.

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The study is limited by the small number of patients and lack of bone biopsy. However, the lower intact PTH, the higher serum calcium level, and the tendency toward lower ALP levels in elderly patients suggest higher prevalence of low bone turnover form of CKD- MBD (adynamic bone disease) in elderly HD patients. The higher prevalence of DM may also have contributed to this problem. Such an observation may have an impact on treatment strategies such as limiting calcium and Vitamin D analog exposure in elderly patients in order to ameliorate low bone turnover disorder in these patients.

Conflict of interest: None declared.



 
   References Top

1.
Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: A position statement from kidney disease: Improving global outcomes (KDIGO). Kidney Int 2006;69:1945-53.  Back to cited text no. 1
    
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). Kidn  Back to cited text no. 2
    
3.
ey Int Suppl 2009;113:1-130.  Back to cited text no. 3
    
4.
Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT. The kidney disease outcomes quality initiative (K/DOQI) guideline for bone metabolism and disease in CKD: Association with mortality in dialysis patients. Am J Kidney Dis 2005;46:925-32.  Back to cited text no. 4
    
5.
United States Renal Data System. 2017 Annual Report. Available from: http://www.usrds.org. [Last accessed on 2018 Sep 30].  Back to cited text no. 5
    
6.
Young EW, Albert JM, Satayathum S, et al. Predictors and consequences of altered mineral metabolism: The dialysis outcomes and practice patterns study. Kidney Int 2005;67: 1179-87.  Back to cited text no. 6
    

Top
Correspondence Address:
Samir H Almueilo
Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam; Department of Internal Medicine and Nephrology, King Fahd Hospital of the University, Alkhobar
Saudi Arabia
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DOI: 10.4103/1319-2442.261364

PMID: 31249245

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