Román-Flores A, Melchor-López A, Huerta-Ramírez S, Cerda-Téllez F, Elizalde-Hernández PD, González-Andujo A, Valdés-Solís E

Language: Spanish
References: 27
Page: 650-659
PDF size: 566.26 Kb.

ABSTRACT

Background: Chronic kidney disease (CKD) is a public health problem, the most serious manifestation of CKD, subsidiary chronic renal disease on dialysis therapy or kidney transplantation, has an incidence and prevalence increasing for two decades. These patients are at high cardiovascular risk and suffer morbidity and mortality from cardiovascular events. The mineral and bone disorder (MBD) is a common manifestation of CKD and contributes to the high risk of fractures and cardiovascular mortality in these patients. Definitive diagnosis is based on histological (histomorphometric) analysis of bone biopsy material with the support of radiological changes and changes in levels of surrogate markers laboratory. Of these various markers, parathyroid hormone (PTH) has been considered to be the most sensitive and is currently the most commonly used. An alternative or complementary approach using alkaline phosphatase (ALP), which is directly related to bone turnover is proposed, reflecting bone histomorphometry. The limitation of laboratory studies in various hospitals for diagnosis leads us to value cheaper and more effective options of assessment.
Objective: To assess whether the determination of alkaline phosphatase can function as parallel marker to PTH in the diagnosis of secondary hyperparathyroidism in chronic kidney disease.
Material and method: A cross-sectional study and analytical correlation was done with clinical records of patients of internal medicine hospital health secretary of Mexico City, having the diagnosis of chronic kidney disease who were on replacement therapy in renal function. It was considered the following laboratory parameters: serum glucose determination, creatinine, BUN, urea, hemoglobin, parathyroid hormone, alkaline phosphatase, calcium, phosphorus and calcium/phosphorus product was determined. One review of the record was made seeking as the end point if there was a correlation between elevated alkaline phosphatase and parathyroid hormone and as a secondary point if it can be useful as an alternative marker for diagnosis of secondary hyperparathyroidism in patients with chronic disease was made. Correlation between serum PTH and alkaline phosphatase value where linear regression was applied and tested using Pearson correlation for both, in order to determine whether there is a direct relationship between them, yielding correlation and significance was conducted.
Results: The average PTH and alkaline phosphatase were 1,599 and 621, respectively; correlation between PTH and alkaline phosphatase was statistically significant (with a correlation index of 0.27 and p less than 0.001); it was also showed that for every unit of PTH, alkaline phosphatase increased 56 units.
Conclusions: The determination of alkaline phosphatase can be used as an alternative in the diagnosis of secondary hyperparathyroidism in CKD patients on peritoneal dialysis, since it is an affordable resource for patients.

REFERENCES

1. García-Cruz E, Elizalde Barrera CI, Lozano Nuevo JJ. Inicio de diálisis en forma temprana posterior a la colocación de catéter blando como factor de riesgo para disfunción y disminución de la efectividad de la diálisis peritoneal. Med Int Mex 2010;26:552-560.

2. Méndez-Durán A, Méndez-Bueno JF, Tapia-Yáñez T, Muñoz- Montes A y col. Epidemiología de la insuficiencia renal crónica en México.

3. Guía de referencia rápida. Diagnóstico y tratamiento de la peritonitis infecciosa en la diálisis peritoneal crónica en adultos. México: Instituto Mexicano del Seguro Social, 2009.

4. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002;39(Suppl 1):S1-266.

5. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care Clin Office Pract 2008;35:329-344.

6. Pendse S, Singh AK. Complications of chronic kidney disease: anemia, mineral metabolism, and cardiovascular disease. Med Clin N Am 2005;89:549-561.

7. Griveas I. Comparison of blood and peritoneal lymphocytes from continuous ambulatory peritoneal dialysis patients, asymptomatic and with peritonitis. Ren Fail 2006;28:237-239.

8. Kir HM. Effects of chronic kidney disease and type of dialysis on serum levels of adiponectin, TNF-alpha and high sensitive C-reactive protein. Clin Lab 2012;58:495-500.

9. Instituto Nacional de Estadística y Geografía. Defunciones generales totales por principales causas de mortalidad, 2010.

10. Foley RN. Infections in patients with chronic kidney disease. Infect Dis Clin N Am 2007;21:659-672.

11. Sardiwal S, Magnusson P, Goldsmith DJA, Lamb EL. Am J Kidney Dis 2013;62:810-822.

12. Sayed Ahamed NA, Abdul-Aziz MY, El-Bauomy AA, Salem TS. Parathyroid hormone: effects on glucose homeostasis and insulin sensitivity in chronic renal failure patients on regular hemodialysis. J Taibah University Medical Sciences 2008;3:44-54.

13. Fukushima N, Suzuki A, Fukushima K, Tanaka Y, et al. Impact of the serum bone-specific alkaline phosphatase level at the initiation of hemodialysis therapy for end-stage renal disease on cardiovascular events. IJC Metabolic & Endocrine 2014;4:58-62.

14. Tsumura M, Ueno Y, Kinouchi T, Koyama I, Komoda T. Atypical alkaline phosphatase isozymes in serum and urine of patients with renal failure. Clin Chim Acta 2001;312:169-178.

15. Delanaye P, Dubois BE, Jouret F, Krzesinski JM, et al. Parathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients: Is it so simple. Clin Chim Acta 2014; 417:35-38.

16. Zhou S, LeBoff MS, Waikar SS, Glowacki J. Vitamin D metabolism and action in human marrow stromal cells: Effects of chronic kidney disease. J Steroid Biochem Molecular Biol 2013;136:342-344.

17. Kobayashi I, Shidara K, Okuno S, Yamada S, et al. Higher serum bone alkaline phosphatase as a predictor of mortality in male hemodialysis patients. Life Sciences 2012;90:212-218.

18. Furuhashi T, Moroi M, Joki N, Hase H, et al. The impact of chronic kidney disease as a predictor of major cardiac events in patients with no evidence of coronary artery disease. J Cardiol 2010;55:328-336.

19. Russo D, Corrao S, Battaglia Y, Andreucci M, et al. Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 2011;80:112-118.

20. Mizobuchi M, Towler D, Slatopolsky E. Vascular calcification: the killer of patients with chronic kidney disease. J Am Soc Nephrol 2009;20:1453-1464.

21. Young EW, Albert JM, Satayathum S, Goodkin DA, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2005;67:1179-1187.

22. Dusso A. Kidney disease and vitamin D levels: 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and VDR activation. Kidney Int 2011;(Suppl. 1):136-141.

23. Rodríguez-Farré N, Jiménez-Torrecilla I, Méndez-Landa C, Canal-Girol C y col. Diagnóstico y tratamiento de las alteraciones oseominerales asociadas a la enfermedad renal crónica. Dial Traspl 2010;31:79-85.

24. Moe S, Drueke T, Cunningham J, Goodman W, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: Improving Global Outcomes (KDIGO). Kidney Int 2006;69:1945-1453.

25. Torregrosa JV, Bover J, Cannata AJ. Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (SENMBD). Nefrologia 2011;31(Suppl. 1):1-32.

26. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001;38:938-942.

27. Levin A, Bakris GL, Molitch M, Smulders Met al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71:31-38.