BACKGROUND The term ‘Chronic Kidney Disease-Mineral and Bone Disorder’ (CKD-MBD) has been used to describe clinically, the abnormalities in the bone and mineral metabolism associated with CKD. In CKD, serum levels of metabolic bone disease markers generally reflect a high bone turnover state (hyperphosphatemia, hypocalcaemia, hypersecretion of PTH, increased ALP). However, it has been noted that in diabetic CKD patients on regular haemodialysis, there is an impaired secretion of PTH when compared to the non-diabetics on haemodialysis. In this study we intend to evaluate the serum bone markers in both diabetic and nondiabetic CHD patients. If a significant association can be demonstrated between diabetes mellitus and a low bone turnover state, then treatment guidelines can be tailored accordingly in the diabetic CHD patients. METHODS A hospital based cross-sectional study was done on 150 patients attending the Dialysis Unit of Govt. Medical College, Thrissur district, Kerala, India, from March 2014 to March 2015. Estimation of serum FBS, creatinine, calcium, phosphorus, ALP and PTH was done. RESULTS The mean levels of serum phosphorus and PTH are significantly lower in the diabetic CHD population than in the non-diabetics, but mean serum ALP is significantly higher in the diabetic CHD patients. Statistical significance is seen in the serum metabolic bone disease markers except calcium among diabetic and non-diabetic chronic kidney disease. CONCLUSIONS The serum levels of PTH and phosphorus were found to be significantly lower in diabetic CHD patients than in their non-diabetic counterparts. Serum ALP levels were significantly higher in the diabetics. This demonstrates that a relative hypoparathyroidism is prevalent among the diabetic CHD patients and hence, prevention of deterioration of the already existing low turnover bone disease in such patients should be the treatment motto. Avoidance of oral calcium supplements, vitamin D supplements and increased calcium in the dialysate would be ideal, since these can lead to hypercalcemia and further suppress the PTH secretion. KEYWORDS Diabetes Mellitus, Chronic Kidney Disease, Bone Markers
Posttranslational Heterogeneity of Bone Alkaline Phosphatase in Metabolic Bone Disease