Parathyroid hormone and biochemical profile in chronic kidney disease patients in South India

Abstract

Renal osteodystrophy is an important complication of chronic kidney disease characterized by abnormal bone turnover with varied bone histologic changes. Etiology is multifactorial including abnormalities of serum calcium, phosphorus, and 1,25(OH)(2)-vitamin D deficiency; secondary hyperparathyroidism; age; cause of kidney disease; diet; renal replacement therapy; and drug therapy. In addition, there is evidence that there may be ethnic differences. Our study is a description of a case series of hormonal and biochemical abnormalities of bone disease in end-stage renal disease patients in South India. A total of 115 patients were studied; 86% were on hemodialysis and 14% were on peritoneal dialysis (age, 47.31 +/- 14.66 years). Sixty-eight percent were men. Diabetes was the cause of end-stage renal disease in 29.5%. Intact parathyroid hormone (PTH) level was 124.6 +/- 174.9 pg/mL and less than twice normal in 69.5% of patients. Hypocalcemia was present in 16.5% and hyperphosphatemia in 35.7% of patients. Empirical vitamin D was prescribed in 40% of patients. Age, sex, diabetic status, and vitamin D use were similar in patients with high PTH (130 pg/mL) and low PTH levels (< 130 pg/mL). Bone histologic studies were not performed owing to economic limitation. But the biochemical and hormonal results are suggestive of a mild form of osteodystrophy in Indian patients. Etiology remains uncertain but differences in dietary intake, tropical climate, vitamin D activation, vitamin D receptor polymorphism, parathyroid gland sensitivity, and PTH target organ sensitivity may account for the difference in pattern in bone disease.

Predictors of quality of life of hemodialysis patients in India

“…The mean age of our cohort was comparable to the Bengaluru,[27] and Chennai[29] studies and older to the Vellore[30] study. The low mean duration of dialysis in our study and other studies[272930] from India is due to high attrition rate largely due to financial reasons.…”

“…The low mean duration of dialysis in our study and other studies[272930] from India is due to high attrition rate largely due to financial reasons. The dialysis prescription was empiric and not based on measures of dialysis adequacy and is a common practice in most centers in our country[2731] and varied between less than twice weekly to thrice weekly.…”

A comparison of practice pattern and outcome of twice-weekly and thrice-weekly hemodialysis patients

“…[4569] High prevalence of AVF in our study is consistent with previously reported cohorts from India. [610] Diabetic patients were higher in the 3x group aligned with a high prevalence of diabetes in CKD population. [11] The follow-up period for patients in this study may appear short, but it is not insignificant given the duration of survival reported in patients on HD in India.…”

Niacin and analogs for phosphate control in dialysis—perspective from a developing country

“…Data from developing countries on hyperphosphatemia in the dialysis population are scarce. A recent study of dialysis patients in India showed the prevalence of hyperphosphatemia to be 35.7% [7]. Concerns are raised about the propensity of calcium-based phosphate binders to increase vascular calcification.…”