Study of evaluation and correlation of calcium and phosphorus in chronic kidney disease with reference to parathyroid hormone
Keywords:Calcium-Phosphorus product, Chronic kidney disease, Calcium, phosphorus, Parathyroid hormone
Background: Recent guidelines for bone metabolism and disease in CKD recommend that, the target levels for calcium (Ca), phosphorus (P), calcium x phosphorus product(Ca × P) and parathyroid hormone (PTH) levels should be maintained at 8.8-10.2 mg/dl, 2.1-5.6 mg/dl, < 57.1mg2/dl2 and 8.7-79.6 pg/ml, respectively in patients of CKD.
Methods: This was an observational study done in 70 patients, presenting in outpatient and inpatient department of tertiary care multi-specialty teaching hospital. Study was carried out at Dhiraj Hospital, Vadodara, Gujarat, in interval of one and half year.The study was investigation based, in the age group of 18 years and above who presented with chronic kidney disease. Serum Ca and serum P levels were measured by Fully Automated Colorimetry and Parathyroid hormone was measured by FLIA-fluoroscence linked immunoassay.
Results: Among the 70 patients of chronic kidney disease, 55.7% showed abnormal calcium levels, 41.4% showed abnormal phosphorus levels,72.9% showed abnormal PTH levels,11.4% showed abnormal Ca x P levels.
Conclusions: The correlation between the phosphorus and PTH was linear and statistically significant. But the correlation between calcium and PTH was statistically insignificant and between Ca x P and PTH was very weak and statistically insignificant in CKD patients.
Jameson JL, Fauci S, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison’s principles of internal medicine. 20th edition. Mc Graw Hill; 2018:2111.
Alam JM, Baig JA, Asghar SS, Sultana I, Mahmood SR. Correlation of long term chronic renal disease (CKD) with intact PTH (iPTH) and biochemical parameters. Int J Pharm Res Health Sci. 2016;4(2):1092-6.
Jabbar Z, Aggarwal PK, Chandel N, Khandelwal N, Kohli HS, Sakhuja V, et al. Noninvasive assessment of bone health in Indian patients with chronic kidney disease. Ind J Nephrol. 2013 May;23(3):161.
De Paola L, Coppolino G, Bolignano D, Buemi M, Lombardi L. Parathyroid hormone variability parameters for identifying high turnover osteodystrophy disease in hemodialysis patients: an observational retrospective cohort study. Thera Aphere Dialysis. 2010 Dec;14(6):566-71.
Sankarasubbaiyan S, Abraham G, Soundararajan P, Chandrasekaran V, Padma G. Parathyroid hormone and biochemical profile in chronic kidney disease patients in South India. Hemodialy Inter. 2005 Jan;9(1):63-7.
Bilal M, Khan RA, Danial K. Hijama improves overall quality of life in chronic renal failure patients: A pilot study. Pak J Pharm Sci. 2015 Sep 1;28(5):1731-5.
Soleymanian T, Nikzad N, Mahjoub A, Argani H, Saavaj S. Serum levels of intact parathyroid hormone, calcium, and phosphorus and risk of mortality in hemodialysis patients. Nephro-Urol Monthly. 2017;9(1).
Vhora RS, Munde A, Bale C, Kakrani AL. Correlation of serum parathyroid hormone with mineral bone disease in chronic kidney disease patients. Med J Dr. DY Patil University. 2015 Nov 1;8(6):708.
De Nicola L, Conte G, Chiodini P, D’Angiò P, Donnarumma G, Minutolo R. Interaction between phosphorus and parathyroid hormone in non-dialysis CKD patients under nephrology care. J Nephrol. 2014 Feb 1;27(1):57-63.
Young EW, Akiba T, Albert JM, McCarthy JT, Kerr PG, Mendelssohn DC, et al. Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004 Nov 1;44:34-8.