الفهرس 
Chronic Kidney Disease-MineralOnly 14 pages are availabe for public view
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Abstract
Disturbances of bone and mineral metabolism are a hallmark of chronic kidney disease (CKD). At the onset of chronic kidney disease, the systemic mineral metabolism and bone composition start to change. This alteration is known as chronic kidney disease - mineral bone disease (CKD-MBD). The greater the decrease in renal function, the worse the progression of CKD-MBD.
Assessment of bone turnover markers (BTMs) has lately been recommended for CKD patients and dialysis patients. Bone mineral density as measured by DEXA relates to fracture risk in patients on hemodialysis. Early recognition and management of the CKD-MBD is an essential step to avoid future complications ultimately impacting outcome.
Our study was conducted in Ain Shams University Hospital, hemodialysis units to study the possible effects of bisphosphonate therapy on DEXA scan & bone alkaline phosphatase in prevalent hemodialysis patients. The study includes 33 prevalent HD patients whom were randomly selected from the HD units.
The patients were divided into 2 groups who were randomized to ibandronic acid (Group A) or placebo (Group B) in a double blind method as follows:
Group A:
Includes 25 patients. This group was commenced on ibandronic acid together with their maintenance Ca and vitamin D supplementation that were taken monthly for 6 months .
Group B:
Includes 8 patients who were given a placebo together with conservative measures in the form of their maintenance Ca and vitamin D supplementations.
All candidates enrolled in this study were subjected to full history taking (including the etiology of ESRD) and physical examination.
Serum chemistries i.e. serum corrected Ca, serum PO4, serum albumin, hemoglobin, level of bone specific alkaline phosphatase by MicroVue BSAP immunoassay and DEXA Scan at the left femoral neck and lumbar vertebrae (L2-L4) at baseline & after the treatment period ( 6 months).
Our study showed there were no significance between-group differences in terms of age, sex, BMI and duration of HD.
T-score measured by DEXA scan at femoral neck region showed shows improvement in bone density in the ibandronate group after 6 months.
Phosphate level, increased statistically significant in group A between baseline and after treatment, while in group B there was no statistically significant change in PO4 level between baseline and after 6 months. However the difference in change between 2 groups was not statistically significant.
Our study showed that level of corrected Ca measured between baseline and after therapy showed no statistically significant change in both groups.
Also, Ca x PO4 product showed no statistically significant change in both groups.
Bone specific alkaline phosphatase level showed statistically significant decrease in group A between baseline and after treatment also in group B, there was statistically significant decrease in b-ALP level before and after 6 months. However the difference in decrease between the 2 groups was not statistically significant.
In conclusion; despite the complexity of skeletal abnormalities associated with reduced renal function and the practical difficulties in the precise diagnosis of the bone architecture in clinical practice, there is evidence to suggest that bisphosphonate treatment reduces fracture risk without an increase in adverse events in patients with CKD. While a dose reduction in such patients may be advocated based on pharmacokinetic studies. Appropriate prospective trial data with bone histomorphometry and clinically important endpoints in the CKD population are awaited to guide therapy.