Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(1):093-099 | DOI: 10.5507/bp.2013.087

Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

Ivo Valkovsky^a,e, Renata Olsanska^a, Josef Tvrdik^f, Arnost Martinek^a,e, Zdenek Svagera^b,e, Marketa Pernicova^c, Jarmila Dedochova^a, Zuzana Cermakova^d,e

^a Clinic of Internal Medicine, University Hospital Ostrava, Ostrava, Czech Republic

^b Institute of Laboratory Diagnostics, University Hospital Ostrava, Ostrava

^c Institute of Radiodiagnostic, University Hospital Ostrava, Ostrava

^d Blood Centre, University Hospital Ostrava, Ostrava

^e Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava

^f Department of Informatics and Computers, Faculty of Science, University of Ostrava, Ostrava

Background: Patients with chronic kidney disease (CKD) have significant disorders of bone and mineral metabolism. In addition, they can also develop other bone disorders including osteoporosis. This study evaluated the bone mineral density (BMD) of patients at the start of hemodialysis treatment as well as the relationship between BMD and possible risk factors or biochemical markers.

Methods: The study was performed in 82 patients (28 females, 54 males). BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur.

Results: We found a high prevalence of 25-hydroxyvitamin D deficiency (96%; mean levels 30.0 ± 17.7 nmol/L) and a reduction of BMD in comparison with gender- and age-matched normal population values at the total hip (Z-score = -0.31 ± 1.11) and the femoral neck (Z-score = -0.48 ± 1.16), but not at the lumbar spine (Z-score = 0.68 ± 1.81). The prevalence of T-scores ≤ -2.5 SD in the group of patients over 50 years was 52.0% in females and 33.3% in males. BMD positively correlated: with male gender and calcium levels at all measured sites, with age at the lumbar spine and with weight or BMI at the proximal femur.

Conclusion: CKD patients at the start of hemodialysis treatment had a high prevalence of low T-score values, corresponding to values for osteoporosis in the general population. BMD at the proximal femur was below the expected average for age and gender, but at the lumbar spine, BMD in hemodialysis patients was above average in persons without known CKD.

Keywords: bone mineral density, DXA, chronic kidney disease, hemodialysis, osteoporosis

Received: May 17, 2013; Accepted: November 18, 2013; Prepublished online: November 29, 2013; Published: March 9, 2015  Show citation