Abstract:
Introduction: Chronic Kidney Disease
(CKD) is a global health problem affecting 5-
10% of the world population. Metabolic bone
disease (MBD) is one of the main
manifestations of CKD, found almost
universally in the patients with CKD stages
3 5. There is lack of scientific evidence on
bone profiles of patients with CKD in Sri
Lanka. Therefore the main objective of the
current study was to describe the pattern of
biochemical markers of MBD in CKD
patients in Kandy, Sri Lanka.
Materials and Methods: CKD patients
(n=110) of stage 3 5 registered in the renal
clinic of Teaching Hospital, Kandy (THK)
were recruited with their written consent.
Blood samples were obtained and
centrifuged. Serum creatinine, calcium,
phosphate, alkaline phosphatase (ALP) and
parathromone hormone (PTH) levels were
determined using the separated serum.
Estimated glomerular filtration (eGFR) was
calculated and data were analysed by using
SPSS (Version 23). Ethical approval was
obtained from Ethical Review Committee of
Faculty of Medicine, University of
Peradeniya.
Results: Of the study cohort, 26% were from
CKD stage 3, 44% were from 4 and 30% were
from 5. Total serum calcium, phosphate, ALP
and PTH levels of CKD patients ranged
between 0.33 2.75 mmol/L, 0.58 3.17
mmol/L, 43.9 651.5 U/L and 8.739
795.677 pg/mL respectively. Forty seven
percent (47%) patients had hypocalcemia,
81% had hyperphosphatemia, 73% had high
ALP and 63% had high PTH. There was a
significant weak, positive correlation
between total calcium level and ALP (r=
0.247, n=110, p<0.01). There was also a
significant moderate positive correlation
between serum phosphate and PTH (r= 0.323,
n = 110, p <0.01). A negative correlation was
observed between serum phosphate level
with calcium (r= -0.367, n=110, p<0.01) and
ALP (r=-0.202, n=110, p<0.01).
Discussion: Reference ranges of calcium,
phosphate, ALP and PTH levels ranged
between 2.1 -2.35 mmol/L, 0.87 1.07
mmol/L, 45 145 U/L and 10 62 pg/mL
respectively. There is sufficient scientific
evidence shown in other countries to prove
hypocalcemia, hyperphosphatemia and high
levels of PTH in CKD patients who belongs
stages 3 -5.
Conclusion: This limited data reveals that
prevalence of markers in MBD among CKD
patients in Kandy, Sri Lanka is similar to the
known pattern of CKD.
