To Study the Altered Calcium Phosphorus Intact Para Thyroid Hormone in Chronic Kidney Disease Patients and Correlate with Bone Denstiometery Analysis

Introduction: The prevalence of Chronic Kidney Disease is large and treatment options nowadays can be accounted for. With advancements in management techniques in follow up, researchers have isolated markers to predict the course of disease and even delay or prevent various grave complications related to CKD. However, the work is still in progress as numerous studies are done to correlate markers/parameters with the CKD natural history. This study attempts to assess altered Calcium, Phosphorous, intact PTH in CKD patients and correlate with Bone Densitometry analysis. Bone remodelling is a dynamic process with an average remodelling cycle of 3-6 months for an area of bone. Therefore, the use of multiple bone biopsies as a gold standard for diagnosing and monitoring renal osteodystrophy is impracticable. There is need for reliable biomarkers for assessing and monitoring patients with CKD-MBD. Therefore, the KDIGO guidelines recommended the use of serum PTH in conjunction with total or bone-specific alkaline phosphatase (b-ALP) since high or low levels of these markers correlate with underlying bone turnover. Objective: To study the altered Calcium Phosphorus iPTH and Vitamin D homeostasis in CKD patients and correlate with altered BMD. Materials and Methods: This study was conducted in a tertiary care centre with 100 subjects of CKD was taken as per inclusion/exclusion criteria mentioned, investigated and various statistical analyses were applied to draw intellectual conclusions. We took two groups as Hyperdynamic bone disease (High turnover) and Adynamic Bone disease and evaluated multiple factors, such as age, sex, individual biomarkers; their relationship with the two groups along with an attempt to correlate with BMD done by DEXA scan, a non-invasive method to assess bone mass/health. Results: We drew outcome that Phosphorous, Calcium, IPTH, BMD, had no significant correlation between age and gender in both groups. Hypercalcemia was associated with Adynamic disease whereas hypocalcemia was found in Hyperdynamic disease. IPTH level was higher in the case of hyperdynamic disease and suppressed with the adynamic disease. The bone mineral metabolism abnormality leads to complicated extraskeletal vascular calcification, increases coronary and cerebrovascular accidents along with diseases of bone and joints. Conclusion: We found statistically significant increase in serum urea, creatinine, phosphorus and parathyroid hormone and decreased level in serum calcium in hyperdynamic disease. In adynamic disease, there was a remarkable increase in serum urea, creatinine, phosphorus, calcium and vitamin D3, and a decrease in parathyroid hormone in CKD patients. Thus, it could be concluded that parathyroid level can be used as a marker to identify the bone mineral disturbance in CKD patients even in the early stages. Serial maintenance of IPTH with BMD for maintaining optimal skeletal health is advised for preventing dysregulated mineral metabolism to reduce morbidity and mortality in CKD patients.