Assessment of chronic kidney disease-mineral and bone disorder in hemodialysis patients according to biomarkers value

Introduction: End-stage renal disease (ESRD) patients are complicated by various disorders including renal osteodystrophy. There are new guidelines for the management of chronic kidney disease-mineral and bone disorder (CKD–MBD). Objectives: The aim of the study was to determine the frequency of CKD-MBD in hemodialysis patients in Lorestan province, Iran according to KDIGO. Patients and Methods: This descriptive, cross-sectional study was carried out on all of the ESRD patients being managed in the hemodialysis centers of Lorestan University of Medical Sciences in 2017. Demographic data were prepared by a questionnaire, and laboratory values by fasting blood samples. Statistical analyses were done by SPSS software at a significance level of 0.05. Results: Out of 110 patients, 42 (38.2%) were female. Sixty-one (55.5 %) of the patients had intact PTH (iPTH) values in the normal range. Patients’ serum calcium values ranged between 5.86 to 11.06 mg/dL; 41(37.3%) of the subjects had serum calcium out of the normal range. The level of serum phosphorus was in normal range in 31 (28.2%) patients. The level of alkaline phosphatase ranged from 134 to 1578 mg/dL; while, 55 patients (50%) had normal values. Vitamin D as 25 (OH) Vit D was in normal range in 30 (27.3 %) patients. Conclusion: The frequency of CKD-MBD is very considerable in our patients because about 100% of our patients have at least one of the biomarkers values to be abnormal. More than forty percent of our patients had iPTH values below or above KDIGO 2017 of target range. Low iPTH values were frequent in our study. We found strong positive correlation between Alp and PTH level, and Alp is a suitable substitute for PTH. Vitamin D values should be regularly checked in our patients because more than 70% of the patients had values below normal range. Modification in dietary regimen, quality of dialysis and regularity in taking drugs in our patients is necessary.