Calcium levels and metabolic disturbance in renal disease patients receiving hemodialysis: a cross sectional study highlighting its association in dialysis patients

Wajeeha Elahi, Ameen Zubair Syed, Bilal Jamil, Madiha Arif, Nazia Qamar, Rahila Adil, Adnan Anwar


Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.

Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.

Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P value=0.44). Median and IQR of phosphate were 4.9 and 3.9-5.7 mg/dl for below 5 years and 4.6 and 3.7-5.5 mg/dl for above 5 years (P value=0.21). Median and IQR of parathyroid hormone were 393 and 212-699 pg/ml for below 5 years and 329 and 128-657 pg/ml for above 5 years. (P value=0.13) Median and IQR of albumin were 4.0 and 3.6-4.2 mg/dl for below 5 years and 4.0 and 3.8-4.3 for above 5 years (P value=0.30). Total of 18 (10.9%) had para thyroidectomy.

Conclusions: Present study showed that significant difference in mineral levels did not exist in patients on hemodialysis as regards to the duration of dialysis. However clinical features had a tendency to decrease as duration of dialysis increased to above 5 years. Para thyroidectomy and itching were two main significant findings in this study.


Calcium, Cross sectional study, Developing country, Hemodialysis, Metabolic disturbance, Renal disease

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Collins AJ, Foley RN, Gilbertson DT, Chen SC. United States renal data system public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl. 2015;5(1):2-7.

Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol. 2015;10(1):98-109.

Fukagawa M, Komaba H. Chronic kidney disease-mineral and bone disorder in Asia. Kid Dis. 2017;3(1):1-7.

Movahed SM, Mousavi SS, Faramarzi M. Secondary hyperparathyroidism among end-stage renal disease patients in Beharlou hospital, Tehran province, Iran. J Parathyroid Dis. 2018;6(2):65-9.

Jovanovich A, Chonchol M. Phosphorus and kidney disease: mechanisms for perturbed phosphorus homeostasis in chronic kidney disease. Clin Aspects Nat Added Phosphorus Foods. 2017:187-99.

Floege J, Kim J, Ireland E, Chazot C, Drueke T, de Francisco A, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant. 2010;26(6):1948-55.

Goodman WG, Quarles LD. Development and progression of secondary hyperparathyroidism in chronic kidney disease: lessons from molecular genetics. Kidney Int. 2008;74(3):276-88.

Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71(1):31-8.

Chertow GM, Plone M, Dillon MA, Burke SK, Slatopolsky E. Hyperparathyroidism and dialysis vintage. Clin Nephrol. 2000;54(4):295-300.

Kim SM, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Rates and outcomes of parathyroidectomy for secondary hyper-parathyroidism in the United States. Clin J Am Soc Nephrol. 2016;11(7):1260-7.

Lacson E, Wang W, Hakim RM, Teng M, Lazarus JM. Associates of mortality and hospitalization in hemodialysis: potentially actionable laboratory variables and vascular access. Am J Kidney Dis. 2009;53(1):79-90.

Martín FJL, Camblor MP, Dionisi MP, Floege J, Ketteler M, London G, et al. Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant. 2015;30(9):1542-51.

Palmer SC, Hayen A, Macaskill P, Pellegrini F, Craig JC, Elder GJ, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA. 2011;305(11):1119-27.

Ketteler M, Elder GJ, Evenepoel P, Ix JH, Jamal SA, Proust LMH, et al. Revisiting KDIGO clinical practice guideline on chronic kidney disease-mineral and bone disorder: a commentary from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2015;87(3):502-8.

Moorthi RN, Moe SM. CKD-mineral and bone disorder: core curriculum 2011. Am J Kidney Dis. 2011;58(6):1022-36.

Hocher B, Pasch A. Hope for CKD-MBD Patients: new diagnostic approaches for better treatment of CKD-MBD. Kidney Dis. 2017;3(1):8-14.

Isakova T, Ix JH, Sprague SM, Raphael KL, Fried L, Gassman JJ, et al. Rationale and approaches to phosphate and fibroblast growth factor 23 reduction in CKD. J Am Soc Nephrol. 2015;26(10):2328-39.

Marks J, Debnam ES, Unwin RJ. Phosphate homeostasis and the renal-gastrointestinal axis. Am J Physiology-Renal Physiol. 2010;299(2):285-96.

Kong X, Zhang L, Chen N, Gu Y, Yu X, Liu W, et al. Mineral and bone disorder in Chinese dialysis patients: a multicenter study. BMC Nephrol. 2012;13(1):116-32.

Kim GH, Choi BS, Cha DR, Chee DH, Hwang E, Kim HW, et al. Serum calcium and phosphorus levels in patients undergoing maintenance hemodialysis: A multicentre study in Korea. Kidney Res Clin Pract. 2014;33(1):52-7.

Kimata N, Albert JM, Akiba T, Yamazaki S, Kawaguchi Y, Fukuhara S, et al. Association of mineral metabolism factors with all‐cause and cardiovascular mortality in hemodialysis patients: The Japan dialysis outcomes and practice patterns study. Hemodialysis Int. 2007;11(3):340-8.

Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, et al. Predictors and consequences of altered mineral metabolism: The Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005;67(3):1179-87.