The Relationship Between Bone Mineral Density And Biochemical Markers Of Bone Metabolism In Patients With Chronic Kidney Disease

Objective Analyze the relationship between bone mineral density(BMD)and bone metabolism biochemical indicators in patients with chronic kidney disease(CKD).Investigate the value of BMD and bone metabolism biochemical indicators in the early diagnosis of chronic kidney disease-minerals and bone metabolism disorders(CKD-MBD).Methods 128 patients with CKD were selected from the nephrology department of the Second Affiliated Hospital of Anhui Medical University from April 2018 to March2018,and 15 healthy persons were included in the control group.The laboratory indexes such as calcium(Ca),phosphorus(P),bone-specific phosphatase(BALP),and parathyroid hormone(PTH),hemoglobin(Hb),albumin(ALB)and serum creatinine(SCr)were measured,Examine BMD of lumbar spine and left hip joint.According to the estimate glomerular filtration rate and dialysis or not,CKD patients were divided into 3stage group 22 cases,4 stage group 22 cases,5 stage non dialysis group(5ND)29 cases,5 stage hemodialysis group(5HD)55 cases,compare the indexes between each group,and the relationship between BMD of lumbar spine and hip was analyzed.Analyze the risk factors influencing BMD of lumbar spine and left hip by multiple linear regression.Results 1.BMD of the hip of 3 stage group(0.99±0.09g/cm~2),4 stage group(0.91±0.14g/cm~2),5ND stage group(0.83±0.92g/cm~2),5HD stage group(0.90±0.15g/cm~2)were lower than the control group(1.15±0.04g/cm~2),and it continued to decrease with the progress of CKD(all P<0.05);there was no significant difference in BMD of lumbar spine between the groups(P>0.05).2.The BALP level of 3 stage group(685.48±128.28pg/ml),4 stage group(909.12±174.78pg/ml),5ND stage group(1209.13±273.39pg/ml),and 5HD stage group(1223.36±397.90pg/ml)were higher than the control group(468.80±59.15pg/ml),and it increased continuously with the progress of CKD(all P<0.05).3.In the 3 stage group,Ca(2.13±0.12mmol/L),P(1.20±0.17mmol/L),and log PTH(1.79±0.30)were still within the normal reference range.Ca in the 5ND stage group were significantly lower than those in the other groups(all P<0.05).P in 5ND stage group and 5HD stage group was significantly higher than other groups(P<0.05),and log PTH level in 5HD stage group was significantly higher than other groups(P<0.05).4.BMD of hip was positively correlated with ALB(P<0.05),and negatively correlated with age,SCr,P,Log PTH,and BALP(all P<0.05);BMD of the lumbar spine and all indexes no correlation(all P>0.05);BALP was positively correlated with age,SCr,P,and Log PTH(all P<0.05),negatively correlated with Hb,ALB,and BMD of hip(all P<0.05),and BMI.No correlation between Ca,and BMD of lumbar spine(all P>0.05).5.Age,BMI,SCr,and PTH are risk factors that affect BMD of hip;PTH are risk factors that affect BMD of lumbar spine.Conclusions Compared with BMD of lumbar spine,BMD of hip is a sensitive index of early bone metabolism abnormalities.BMD of hip gradually decreases with the progression of CKD,and is negatively correlated with PTH and BALP.BALP is positively correlated with PTH.Older age,low BMI,decreased renal function,and high PTH level are risk factors for BMD of hip reduction.Early combined application of BMD of hip measurement,The detection of BALP and PTH levels is of great significance for early detection and management of CKD-MBD.