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Mineral bone disease in maintenance hemodialysis patients: Association with morbidity and mortality
Y N V Reddy1, G Abraham2, Y N V Reddy1
1Department of Nephrology, Madras Medical Mission Hospital and TANKER Foundation, Chennai, India.
Insights
Mineral bone disease in Indian maintenance hemodialysis (MHD) patients is understudied. Higher intact parathyroid hormone (iPTH), vitamin D supplementation, shorter dialysis, and non-vegetarian diets were linked to increased mortality risk.
Area of Science:
- Nephrology
- Endocrinology
- Public Health
Background:
- Mineral bone disease (MBD) is a significant complication in patients undergoing maintenance hemodialysis (MHD).
- Data on MBD prevalence and outcomes in Indian MHD populations are limited.
- Understanding MBD's impact on mortality is crucial for improving patient care.
Purpose of the Study:
- To investigate the clinical characteristics and mortality predictors of mineral bone disease in Indian MHD patients.
- To analyze the association between MBD markers and patient survival.
- To identify factors contributing to mortality in this cohort.
Main Methods:
- Retrospective analysis of 858 MHD patients from two Indian centers (1998-2010).
- Data collected included demographics, dialysis parameters, laboratory values (serum calcium, phosphorus, iPTH, vitamin D), diet, and mortality.
- Statistical analysis to identify factors associated with mortality.
Main Results:
- Overall mortality was 22% during the observation period, with 1-year and 3-year survival rates of 86% and 78%, respectively.
- Higher intact parathyroid hormone (iPTH) levels (P=0.012) were significantly associated with increased mortality.
- Need for vitamin D supplementation (P=0.003), fewer dialysis hours per session (P=0.046), and non-vegetarian diet (P=0.022) were also linked to higher mortality.
Conclusions:
- Mineral bone disease management, particularly controlling iPTH and optimizing vitamin D levels, is critical for MHD patient survival in India.
- Dialysis adequacy (hours per session) and dietary factors play a role in mortality.
- Further prospective studies are needed to confirm these findings and develop targeted interventions.
Abstract:
There is a paucity of data on mineral bone disease in maintenance hemodialysis (MHD) patients from India. This retrospective analysis was undertaken on 858 (males: 599; females: 259) patients from two medical centers on MHD from 1998 to 2010. Age, gender, months on dialysis, hours per session of dialysis, hemoglobin, serum calcium, inorganic phosphorus, intact parathyroid hormone (iPTH), urine output, erythropoietin dosage per week, blood sugar, blood pressure, urea reduction rate, gain in fluid and fluid removed per session, serum albumin, alkaline phosphatase, vitamin D level, supplemental vitamin D and use of phosphate binder for therapy were documented. Overall, 191 patients died (22%) during the observation period. There was an 86% patient survival rate at 1 year on dialysis and an overall predicted 3-year survival rate of 78%. A relatively higher iPTH (P = 0.012), a need for vitamin D supplementation (P = 0.003), less hours on dialysis per session (P = 0.046) and a non-vegetarian diet (P = 0.022) were significantly associated with mortality.
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