Prevalence and pattern of renal osteodystrophy in chronic hemodialysis patients: a cross sectional study of 103 patients

Abstract

This cross sectional study was conducted to determine the prevalence and pattern of renal osteodystrophy (ROD) in patients on maintenance hemodialysis (HD) in Tripoli, Libya. A total of 103 randomly selected patients, of whom 53% were males, were investigated. Their mean age was 47.6 +/- 12.5 years. They were on dialysis for a mean duration of 6.2 +/- 4.3 years. Pre-dialysis serum levels of intact parathyroid hormone (iPTH), osteocalcin, alkaline phosphatase, albumin, total calcium and phosphate were measured in all the patients. Depending on serum iPTH levels, the patients were divided into three groups: hyperparathyroid bone disease (iPTH > 450 pg/ml), adynamic bone disease (iPTH < 60 pg/ml), and a group with apparently normal bone (iPTH 60 pg/ml to 450 pg/ml). As a whole, the mean serum levels of iPTH, osteocalcin, alkaline phosphatase and corrected total calcium were high in all study patients (373.7 pg/ml, 251.3 ng/ml, 254.9 IU/l, and 9.9 mg/dl respectively). The prevalence of ROD among these patients was 55.3%. Of these, 29 (28.1%) had laboratory evidence of hyperparathyroid bone disease, while 28 patients (27.1%) had laboratory evidence of adynamic bone disease. In only 18 patients, (17.4%) the serum levels of iPTH were within the target range recommended by the K/DOQI guidelines (150-300 pg/ml). This cross sectional study, albeit in a limited number of patients, shows that the prevalence of ROD in our institution is high, possibly because of inadequate patient monitoring and lack of insight into ROD among both patients and physicians.