Purnima Eliz Thomas1, M. Pushpalatha2, Shajee Sivasankaran Nair3, Sajeevan Kundil Chandran4
BACKGROUND
The term ‘Chronic Kidney Disease-Mineral and Bone Disorder’ (CKD-MBD) has
been used to describe clinically, the abnormalities in the bone and mineral
metabolism associated with CKD. In CKD, serum levels of metabolic bone disease
markers generally reflect a high bone turnover state (hyperphosphatemia,
hypocalcaemia, hypersecretion of PTH, increased ALP). However, it has been
noted that in diabetic CKD patients on regular haemodialysis, there is an impaired
secretion of PTH when compared to the non-diabetics on haemodialysis. In this
study we intend to evaluate the serum bone markers in both diabetic and nondiabetic
CHD patients. If a significant association can be demonstrated between
diabetes mellitus and a low bone turnover state, then treatment guidelines can be
tailored accordingly in the diabetic CHD patients.
METHODS
A hospital based cross-sectional study was done on 150 patients attending the
Dialysis Unit of Govt. Medical College, Thrissur district, Kerala, India, from March
2014 to March 2015. Estimation of serum FBS, creatinine, calcium, phosphorus,
ALP and PTH was done.
RESULTS
The mean levels of serum phosphorus and PTH are significantly lower in the
diabetic CHD population than in the non-diabetics, but mean serum ALP is
significantly higher in the diabetic CHD patients. Statistical significance is seen in
the serum metabolic bone disease markers except calcium among diabetic and
non-diabetic chronic kidney disease.
CONCLUSIONS
The serum levels of PTH and phosphorus were found to be significantly lower in
diabetic CHD patients than in their non-diabetic counterparts. Serum ALP levels
were significantly higher in the diabetics. This demonstrates that a relative
hypoparathyroidism is prevalent among the diabetic CHD patients and hence,
prevention of deterioration of the already existing low turnover bone disease in
such patients should be the treatment motto. Avoidance of oral calcium
supplements, vitamin D supplements and increased calcium in the dialysate would
be ideal, since these can lead to hypercalcemia and further suppress the PTH
secretion.
