Mohsen Nafar; Tahereh Sabaghian; Alireza Khoshdel; Behrang Alipour; Shiva Samavat
Volume 21, Issue 1 , 2019, Pages 1-9
Abstract
Background: Mineral bone disorder is one of the major factors affecting mortality and morbidity in dialysis patients, which iscalled chronic kidney disease-mineral and bone disorder (CKD-MBD).Objectives: This study aimed to evaluate the laboratory parameters of mineral bone disorder in hemodialysis patients ...
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Background: Mineral bone disorder is one of the major factors affecting mortality and morbidity in dialysis patients, which iscalled chronic kidney disease-mineral and bone disorder (CKD-MBD).Objectives: This study aimed to evaluate the laboratory parameters of mineral bone disorder in hemodialysis patients in Iran andtheir relationship with malnutrition and inflammation.Methods: This multicenter observational study was conducted in 2016 in 58 dialysis centers in Iran. Data of a total number of 7191chronic hemodialysis patients aged older than 18 years with a dialysis duration of > 3 months were collected. Idiopathic hypercalcemia and history of parathyroidectomy were considered as the exclusion criteria. The serum levels of calcium (Ca), phosphorus(P), and intact parathyroid hormone (iPTH) were measured over a period of three months, and the findings were compared withthe K/DOQI (National Kidney Foundation Dialysis Outcomes Quality Initiative) guidelines. Moreover, the serum level of C-reactiveprotein (CRP) and nutritional status based on geriatric nutritional risk index (GNRI) were assessed.Results: The percentage of the patients who had a serum iPTH level of < 150 pg/mL was 46% while that of patients with iPTH of >300 pg/mL was 29.3%. Hypercalcemia and hyperphosphatemia were observed in 20.6% and 34.2% of the patients, respectively. Moreover, 51.7%, 61.3%, 24.7%, and 84.7% of the patients, respectively, reached the K/DOQI target range of Ca, P, iPTH, and Ca × P product.The percentages of mild-to-severe malnutrition based on GNRI in patients whose iPTH level was within, below, and above the recommended range of K/DOQI guidelines were 30.7%, 34.1%, and 25.9%, respectively (P < 0.001). Furthermore, the serum level of CRP wassignificantly higher in low-serum PTH patients than in the other two groups. In total, only could 8.3% of the patients reach the fourKDOQI target levels of CKD-MBD.Conclusions: The findings showed a significant percentage of patients had a low serum PTH level, which might be attributed toinflammatory and nutritional factors. Only had a small percentage of patients reached all the K/DOQI targets. Therefore, the effectsof inflammatory and nutritional factors should also be considered, particularly in developing countries
