Estimation of Serum Vitamin D, Calcium and Phosphorus in Chronic Kidney Disease

Abstract

h y p o c a l c a e m i a a n d c o m p e n s a t o r y hyperparathyroidism. But with advancing disease, the compensatory mechanism can no more maintain the mineral homeostasis and biochemical a b n o r m a l i t i e s l i k e h y p e r p h o s p h a t e m i a , hypocalcaemia and hyperparathyroidism become obvious at stage 4 CKD. 3,4 Besides, decreased kidney function, lack of adequate storage of vitamin D (25, OH vitamin D / calcidiol) is responsible for decreased calcitriol synthesis and its consequences in CKD. 5 Studies have shown vitamin D deficiencies (20-29 ng/ml) and insufficiency (<20 ng/ml) in CKD, both in pre dialysis and maintenance hemodialysis patients, MJSBH Vol 16 Issue 1 Jan-June 2017 30ABSTRACT Introduction: Abnormalities in mineral metabolism are invariable with progressive deterioration of kidney function in chronic kidney disease (CKD). These abnormalities are documented in CKD on dialysis in our population but not on pre dialysis. So, present study aims to estimate serum vitamin D, calcium and phosphorus in CKD stage 3-5ND. Methods: It was a cross sectional study of established new CKD patients not on dialysis, vitamin D, calcium, phosphate binders and corticosteroids therapy. Blood sample was drawn for estimation of serum vitamin D, creatinine, calcium, phosphorus and albumin and CKD staging done by KDIGO (2012) criteria. SPSS software version 19 was used for data analysis and chi-squared and ANOVA test was applied as the test of significance. Results: Sixty six (51 male and 15 female) CKD patients with a mean age of 54.3±14.8 years were studied. Hypovitaminosis D (<30 ng/ml) was present in 84.8%, with deficiency (<20 ng/ml) in 50% and insufficiency (20-30) ng/ml in 34.8%. Other abnormalities observed were hypocalcemia (60.6%), hypercalcemia (1.5%) and hyperphosphatemia (63.6%) with no difference of corrected calcium, significant difference of serum phosphorus (p<0.001) with hyperphosphatemia in stage 4 and 5 CKD and vitamin D insufficiency in stage 3b, deficiency in stage 3a, 4 and 5 CKD. There was no correlation of serum vitamin D with calcium and phosphorus in different stages of CKD. Conclusion: Present study concludes that hypovitaminosis D, hypocalcemia and hyperphosphatemia is common in our pre-dialysis CKD patients and serum phosphorus raises more with reduction of GFR.

Efficacy of hemodialysis and other therapeutic measures in controlling hypocalcemia, hyperphosphatemia and elevated ALP in a group of patients with end-stage renal disease

“…Ying-Ping sun has observed that 34% of studied patients had hypocalcemia and the mean serum calcium level was 8.9 mg/dl which are nearly comparable to the results of the current study (10) , while a similar study performed in India has shown a much less prevalence of hypocalcemia reaching 15.6% (11) .In Nepal, Rajbhandari A and his colleagues have shown a significantly higher prevalence reaching 75% of the studied patients with stage 5 CKD in the predialysis state, where mean serum calcium level was 8.0 mg/dl (12) .These studies and many others highlight the relative difficulties in controlling hypocalcemia in patients with CKD on hemodialysis despite daily supplement of both vitamin D and calcium which necessitate more aggressive therapy although infrequent studies have shown a much better result with normal mean serum calcium or very low prevalence of hypocalcemia among the studied patients (6,13) .…”

Cardiovascular Risk Factors in Pre-dialysis Chronic Kidney Disease patients of Nepal

“…An earlier study reported from our institute also revealed a significant rise of serum phosphate with negative correlation with eGFR (p<0.001) and significantly higher prevalence of hyperphosphatemia (p<0.001) in stage 5 CKD. 12 However, the prevalence of hyperphosphatemia was much lower (42%) in our study than reported before from Nepal (63.6%) 12 and abroad (63.2%). 31 The lower prevalence of hyperparathyroidism affecting only 12% of CKD stage 5 in our study compared to 55.1% in Japanese CKD population 9 might be because of the cut off levels of parathyroid hormone used for risk stratification.…”

“…39 Significant reduction of serum albumin from stage 3 to 5 predialysis CKD patients observed in present study (p<0.03) is similar to other studies in abroad 9 and in Nepal. 12 However, hypoalbuminemia, a marker of malnutrition, found in 93% of our study population with no difference between the CKD stages contradicts the prevalence of 35.5% reported from Nigeria by Adejumo et al 31 with significant increase of hypoalbuminemia from CKD stage 3 to stage 5.…”

“…8,9 Studies reported from Nepal have shown that there is a high risk of traditional CVD risk factors in CKD patients than those without CKD. 10 This is associated with rising prevalence of anemia, 11 hypoalbuminemia and hyperphosphatemia 12 with increasing CKD stages. Thus, the present study aimed to assess the prevalence of individual and cumulative traditional and nontraditional risk factors, their association with status of kidney function and left ventricular hypertrophy in predialysis Nepalese CKD patients.…”

Biochemical spectrum of parathyroid hormone disorders in patients attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal

“…The altered metabolism of calcium, phosphate, and iPTH has commonly seen in chronic kidney disease patients. 32 , 33 The severity of hyperphosphatemia and hyperparathyroidism rises with the increasing severity of CKD, and both are linked with increased cardiovascular disease (CVD) events. 30 Hyperphosphatemia is associated with increased risk for death, CVD events, and vascular calcification among patients with and without kidney disease and high iPTH is associated with CVD events even in CKD stages 3 and 4.…”