Mineral-Bone Disorders in Chronic Hemodialysis Patients in Sub-Saharan Africa: Dakar Experience (Senegal West Africa)

Introduction: Mineral bone disorders (BMD) are almost constant complications in chronic hemodialysis patients. The objective of our study was to determine the prevalence and profiles of BMD in chronic hemodialysis patients. Patients and methods: This is a six-year descriptive and analytical retrospective study from January 1st, 2010 to December 31st, 2015, at the hemodialysis department of the University Hospital Center (CHU) Aristide Le Dantec. Were also included patients on chronic hemodialysis for at least 3 months, with at least one prescribed amount of parathyroid (PTH). For each included patient, the epidemiological, dialytic, diagnostic and therapeutic parameters were collected and analyzed. Results: Over 86 patients, 71 (82.5%) had BMD. The average age was 48.92 ± 15.5 years old, with a sex ratio of 0, 65. Nephroangiosclerosis was the most frequent initial nephropathy (56.3%). The dialysis seniority was 5.2 ± 2.9 years old and 93% of patients profited from 3 sessions of 4 hours per week. Eleven patients (15.5%) had previous aluminum intoxication. Fifty-eight patients (81.6%) had secondary hyperparathyroidism, 12.6% had adynamic osteopathy (OA), and 1.4% had osteomalacia. In patients with secondary hyperparathyroidism, the average age was 48.6 ± 15 years old. 37.9% of these patients had articular pains, 22.4% had bone pains and 13.8% had spontaneous fractures. Eleven patients had hypocalcemia and only one patient had mild hypercalcemia. 46.5% of patients had normal phosphatemia; 29.3% had hypophosphatemia and 24.13% had hyperphosphatemia. Average PTH was 913.85 ± 331.65 ng/ml. 73% of patients had 25-OH-Vit D insufficiency; 72.7% of patients had high total PAL. Therapeutically, 91.4% of patients had been treated with calcium carbonate; 25.9% with a treatment based on non-calcium phosphorus chelators; 69% of patients received vitamin D and 15.5%, calcimimetic treatment. 22% of patients under medical treatment normalized their PTH. Parathyroidectomy was performed in 6.9% of patients. The average age in patients which presented an adynamic osteopathy was 50 ± 20 years old. The average PTH was 56.86 ng / ml, the average calcemia was 100 ± 4.3 mg/l, the average phosphatemia level was 59.5 ± 31.1 mg/l and the average vitamin D was 17, 42 ng / l. Twenty-three patients (32.4% of cases) had vascular calcifications. They were valvular in 25.4% of cases. Conclusion: the BMD remain frequent in our hemodialysis center and dominated by the secondary hyperparathyroidism. A strict and early prevention strategy is necessary to control and delay the appearance of troubles= for a better quality of life for this population.Introduction: Mineral bone disorders (BMD) are almost constant complications in chronic hemodialysis patients. The objective of our study was to determine the prevalence and profiles of BMD in chronic hemodialysis patients. Patients and methods: This is a six-year descriptive and analytical retrospective study from January 1st, 2010 to December 31st, 2015, at the hemodialysis department of the University Hospital Center (CHU) Aristide Le Dantec. Were also included patients on chronic hemodialysis for at least 3 months, with at least one prescribed amount of parathyroid (PTH). For each included patient, the epidemiological, dialytic, diagnostic and therapeutic parameters were collected and analyzed. Results: Over 86 patients, 71 (82.5%) had BMD. The average age was 48.92 ± 15.5 years old, with a sex ratio of 0, 65. Nephroangiosclerosis was the most frequent initial nephropathy (56.3%). The dialysis seniority was 5.2 ± 2.9 years old and 93% of patients profited from 3 sessions of 4 hours per week. Eleven patients (15.5%) had previous aluminum intoxication. Fifty-eight patients (81.6%) had secondary hyperparathyroidism, 12.6% had adynamic osteopathy (OA), and 1.4% had osteomalacia. In patients with secondary hyperparathyroidism, the average age was 48.6 ± 15 years old. 37.9% of these patients had articular pains, 22.4% had bone pains and 13.8% had spontaneous fractures. Eleven patients had hypocalcemia and only one patient had mild hypercalcemia. 46.5% of patients had normal phosphatemia; 29.3% had hypophosphatemia and 24.13% had hyperphosphatemia. Average PTH was 913.85 ± 331.65 ng/ml. 73% of patients had 25-OH-Vit D insufficiency; 72.7% of patients had high total PAL. Therapeutically, 91.4% of patients had been treated with calcium carbonate; 25.9% with a treatment based on non-calcium phosphorus chelators; 69% of patients received vitamin D and 15.5%, calcimimetic treatment. 22% of patients under medical treatment normalized their PTH. Parathyroidectomy was performed in 6.9% of patients. The average age in patients which presented an adynamic osteopathy was 50 ± 20 years old. The average PTH was 56.86 ng / ml, the average calcemia was 100 ± 4.3 mg/l, the average phosphatemia level was 59.5 ± 31.1 mg/l and the average vitamin D was 17, 42 ng / l. Twenty-three patients (32.4% of cases) had vascular calcifications. They were valvular in 25.4% of cases. Conclusion: the BMD remain frequent in our hemodialysis center and dominated by the secondary hyperparathyroidism. A strict and early prevention strategy is necessary to control and delay the appearance of troubles= for a better quality of life for this population.