The Research Of Bone Metabolism Clinical Indexes Of Patients With Chronic Renal Disease

The research of bone metabolism clinical indexes of patients with chronicrenal diseaseBackground: The definition criterion of the Chronic Kidney Disease(CKD) was re-created by the American National Kidney Foundation K/DOQIAdvisory commission in 2006. There has not been final conclusion of whenthe Renal Osteodystrophy (ROD) will emerge, which is one of the maincomplications of the CKD. Many manifestations indicated that the abnormalmetabolism of mineral and bone correlated with the cardiovascularcalcification and the increase of the incidence and mortality. In thelatest 20 years, because of the development of the hemopurification, thelifetime of the CKD patient has been prolonged gradually, the incidenceof ROD increases. The influence of ROD to CKD patients is more prominentthan before and becomes an important factor about the survival and lifequality, so weather the ROD can be diagnosed early and treated effectivelyis the key point of the preventing and controlling. Because the invasivemethod-bone biopsy is needed for diagnosis, it can not be accepted orredone easily. All of the domestic and foreign researches are around theexploring of the meanings about the noninvasive index of the diagnosisof CKD.Objective: To discuss the changing of the serum index related withROD, bone mineral density, bone mineral content in every stages of CKDand the correlations between them, so as to diagnose the CKD early.Methods: Altogether 78 patients were diagnosed with the definitioncriterion of the CKD created by American National Kidney Foundation K/DOQIAdvisory commission, then were divided groups according the creatinineclearance(Ccr) calculated with the Cockcroft-Gault formula. Serumcalcium, phosphorus, Alkalinity phosphatase, BUN, Cr were tested by Colorimetric Detection. Bone gla-protein(osteocalcin) and Calcitoninwere tested by radioimmunoassay. Serum intact Parathyroid hormone wastested by chemiluminescent enzyme immunoassay. Serum osteoprotegerin(OPG)was tested by Double-antibodies-sandwich-ELISA Method. The bone mineraldensity and bone mineral content of the lumbar vertebra L2-L4, femoralneck, Warder triangle, tmuchbone rotor were tested by Dual Energy X-photonAbsorptionmetry. The results were treated with statistical analysis. Alldates were expressed as means±SEM. One way analysis of variance(F test)was used in the group compare. Pearson correlation was used in thecorrelation analysis. Curve regression was used in the regressionanalysis.Result: The age of the patients has positive correlation with OPG(r=0.269, P＜0.05), Ccr has the negative correlation with serum P(r=-0.491,P＜0.001), iPTH(r=-0.454, P＜0.001), BGP(r=-0.331, P＜0.001), OPG(r=-0.702,P＜0.001) respectively. One way analysis of variance indicates muchstatistical meaning of the differences of the groups P(F=10.56, P＜0.01),iPTH(F=6.608, P＜0.01), BOP(F=7.749, P＜0.01), OPG(F=52.192, P＜0.01). Ingroup analysis indicates the obvious increase of the serum P, iPTH, BGP,OPG in renal failure state. The results of lumbar vertebra BMD(F=3.937,P＜0.01), femoral neck BMD(F=4.983, P＜0.01), Warder triangle BMD(F=11.030,P＜0.01) and tmuchbone rotor BMD(F=4.381, P＜0.01) illustrate the muchstatistical meanings of the group differences. The Warder triangle BMDdecreases significantly in CKD4, while the others decreases in CKD5. Theserum P, iPTH, BGP, OPG has positive correlations each other. The positivecorrelations exist in the compare of the P and iPTH(r=0.570, P＜0.001),P and BGP(r=0.443, P＜0.001), P and OPG (r=0.506, P＜0.001), iPTH andBGP(r=0.796, P＜0.001), iPTH and OPG (r=0.386, P＜0.001), BGP and OPG(r=0.364, P＜0.001). Warder triangle has the positive correlation with the Ccr(r=0.807, P＜0.001), while the negative correlations with theP(r=-0.448, P＜0.05), BGP(r=-0.508, P＜0.01), iPTH(r=-0.592, P＜0.01), OPG(r=-0.476, P＜0.01) respectively. The analysis does not indicate thecorrelation between the Calcitonin and other serum indexes or BMDs ofdifferent positions.Conclusion: The concentration of OPG of CKD patient increases WhileCcr decreases, especially after entry the CKD4, the OPG concentration ofCKD4 is 2.3 times as much as CKDI, the OPG concentration of CKD5 is 2.5times as much as CKDI, respectively, while the OPG concentration whenhehodialysis duration is more than 3 months is 3.9 times as much as CKD1.OPG can be made as one of the serum markers of the abnormal ROD bonemetabolism of CKD patients. The obvious increasing of the OPGconcentration of the patients whose hemodialysis duration is more than3 months compared with those in primary stage of hemodialysis indicatesthat the OPG concentration may increase as the hemodialysis duration isprolonged. The OPO concentration of CKD patient increases as the ageincreases. The reciprocal of creatinine clearance rate(1/Ccr) haspositive relation of serum OPG concentration. The OPG concentration canbe predicted with the Ccr of CKD patient. Warder triangle BMD has decreasedevidently in CKD4 in this research, and has a good positive relation ofserum indexes. It is a sensitive index and maybe useful to diagnose theabnormal metabolism of CKD patient early. Tmuchbone rotor BMD decreasesonly in CKD5, and it is only useful for the diagnosis of abnormalmetabolism of severe renal failure patient. When renal function goes ondecreasing, the serum P, iPTH, BOP, OPG increases, while bone mineraldensity decreases. With combined tests of P, iPTH, BGP, OPG and Wardertriangle BMD the bone mineral change can be evaluated synthetically, andthis method can bemade as a noninvasive method of early diagnosis of ROD. There are not obvious differences of serum CT concentrations betweendifferent CKD patients with different degree of renal function injuryfound.