Prevalence and factors associated with mineral bone disorder among patients with chronic kidney disease attending Bugando medical centre
Florence Jared Mtei [Female]
Prevalence and factors associated with mineral bone disorder among patients with chronic kidney disease attending Bugando medical centre - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017 - xiii;57 Pages Includes References and Appendices
ABSTRACT:
Background: Mineral bone disorder is a significant problem among patients with chronic kidney disease. This has been extensively studied in developed countries and shown to be associated with increased morbidity and mortality in this subgroup of patients. The literature on the magnitude of the problem is still scarce in our setting.
Objective: To determine prevalence and factors associated with mineral bone disorder among patients with CKD at Bugando Medical centre and to compare this prevalence with patients who do not have CKD.
Methods: This was a cross sectional study done between November 2016 to March 2017 among patients with and without chronic kidney disease. Social-demographic factors, clinical features and laboratory results regarding bone minerals and renal functions were collected in a special tool and analyzed using STATA 13.
Results: A total of 191(122 with CKD) were enrolled in the study. MBD was found in 139 (72.8%) of the study participants. The prevalence was significantly higher among patients with CKD as compared to controls (82.8% vs.55.1 %, p value <0.0001). The odds of having mineral bone disease among patients with CKD was strongly associated with eGFR< 60 kg/min/m2 (OR 3.39:95% CI [1.16 - 9.97] p-value 0.03).
Conclusion: The mineral bone disorder is prevalent among adult patients with CKD and it is significantly associated with eGFR< 60mls/min/1.73m2. Given the morbidity associated with mineral bone disorder and the difficulty of reversing its effects once it occurs, efforts to prevent CKD could potentially reduce the magnitude of this problem in this subgroup of patients.
= OPERATIONAL DEFINITIONS Chronic kidney disease (CKD): 2. CKD - For the purposes of this study case with CKD Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or eGFR ≤60mls/min/1.73m2 for ≥3months with or without kidney damage(1). Was defined as those with eGFR ≤60mls/min/1.73m2 or those with eGFR ≤90mls/min/1.73m2 with proteinuria >30mg/dl. OPERATIONAL DEFINITIONS CKD - For the purposes of this study case with CKD Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or eGFR ≤60mls/min/1.73m2 for ≥3months with or without kidney damage(1). Was defined as those with eGFR ≤60mls/min/1.73m2 or those with eGFR ≤90mls/min/1.73m2 with proteinuria >30mg/dl. 3. CKD-MBD: Defined according to KDIGO guideline as systemic disorder of mineral and bone metabolism due to CKD, manifested by either one or a combination of the following three components: Abnormalities of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D metabolism Abnormalities in bone turnover, mineralization, volume linear growth, or strength Extra-skeletal calcification (vascular or other soft tissue calcification) (1). 4. CKD-MBD – For practical purposes of this study: Was defined as any abnormal level of corrected calcium for serum albumin <2.2mmol/L, phosphate >1.45mmolL or intact parathyroid hormone>80pg/ml(appendix 5) = ABBREVIATIONS ALP Alkaline phosphatase BMC Bugando Medical Centre CKD Chronic kidney disease CUHAS Catholic University of health and allied sciences DM Diabetes mellitus eGFR estimated glomerular filtration rate FGF-23 Fibroblast Growth Factor 23 GFR Glomerular filtration rate HIV Human immunodeficiency virus HTN Hypertension IPTH Intact Parathyroid hormone KDIGO Kidney disease improving global outcome MBD Mineral bone disorder PTH Parathyroid hormone S. Alb Serum Albumin S.ca Serum calcium S.P Serum phosphate
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
-- Internal Medicine
Prevalence and factors associated with mineral bone disorder among patients with chronic kidney disease attending Bugando medical centre - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017 - xiii;57 Pages Includes References and Appendices
ABSTRACT:
Background: Mineral bone disorder is a significant problem among patients with chronic kidney disease. This has been extensively studied in developed countries and shown to be associated with increased morbidity and mortality in this subgroup of patients. The literature on the magnitude of the problem is still scarce in our setting.
Objective: To determine prevalence and factors associated with mineral bone disorder among patients with CKD at Bugando Medical centre and to compare this prevalence with patients who do not have CKD.
Methods: This was a cross sectional study done between November 2016 to March 2017 among patients with and without chronic kidney disease. Social-demographic factors, clinical features and laboratory results regarding bone minerals and renal functions were collected in a special tool and analyzed using STATA 13.
Results: A total of 191(122 with CKD) were enrolled in the study. MBD was found in 139 (72.8%) of the study participants. The prevalence was significantly higher among patients with CKD as compared to controls (82.8% vs.55.1 %, p value <0.0001). The odds of having mineral bone disease among patients with CKD was strongly associated with eGFR< 60 kg/min/m2 (OR 3.39:95% CI [1.16 - 9.97] p-value 0.03).
Conclusion: The mineral bone disorder is prevalent among adult patients with CKD and it is significantly associated with eGFR< 60mls/min/1.73m2. Given the morbidity associated with mineral bone disorder and the difficulty of reversing its effects once it occurs, efforts to prevent CKD could potentially reduce the magnitude of this problem in this subgroup of patients.
= OPERATIONAL DEFINITIONS Chronic kidney disease (CKD): 2. CKD - For the purposes of this study case with CKD Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or eGFR ≤60mls/min/1.73m2 for ≥3months with or without kidney damage(1). Was defined as those with eGFR ≤60mls/min/1.73m2 or those with eGFR ≤90mls/min/1.73m2 with proteinuria >30mg/dl. OPERATIONAL DEFINITIONS CKD - For the purposes of this study case with CKD Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or eGFR ≤60mls/min/1.73m2 for ≥3months with or without kidney damage(1). Was defined as those with eGFR ≤60mls/min/1.73m2 or those with eGFR ≤90mls/min/1.73m2 with proteinuria >30mg/dl. 3. CKD-MBD: Defined according to KDIGO guideline as systemic disorder of mineral and bone metabolism due to CKD, manifested by either one or a combination of the following three components: Abnormalities of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D metabolism Abnormalities in bone turnover, mineralization, volume linear growth, or strength Extra-skeletal calcification (vascular or other soft tissue calcification) (1). 4. CKD-MBD – For practical purposes of this study: Was defined as any abnormal level of corrected calcium for serum albumin <2.2mmol/L, phosphate >1.45mmolL or intact parathyroid hormone>80pg/ml(appendix 5) = ABBREVIATIONS ALP Alkaline phosphatase BMC Bugando Medical Centre CKD Chronic kidney disease CUHAS Catholic University of health and allied sciences DM Diabetes mellitus eGFR estimated glomerular filtration rate FGF-23 Fibroblast Growth Factor 23 GFR Glomerular filtration rate HIV Human immunodeficiency virus HTN Hypertension IPTH Intact Parathyroid hormone KDIGO Kidney disease improving global outcome MBD Mineral bone disorder PTH Parathyroid hormone S. Alb Serum Albumin S.ca Serum calcium S.P Serum phosphate
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
-- Internal Medicine