Efficacy of hemodialysis and other therapeutic measures in controlling hypocalcemia, hyperphosphatemia and elevated ALP in a group of patients with end-stage renal disease

Abstract

Chronic kidney disease represents (CKD) a major global cause of morbidity and mortality. Its prevalence increased with the increased prevalence of hypertension and diabetes mellitus. CKD is associated with a wide range of metabolic disturbance including hypocalcemia and hyperphosphatemia which are usually associated with high activity of serum alkaline phosphatase (ALP). These disturbances require careful assessment and proper management as they are predictors of poor prognosis. Unfortunately, in many instances, the correction of these disturbances is relatively difficult. The current study aims to evaluate the serum levels of calcium, phosphorus, and ALP in a group of patients with CKD on hemodialysis. A total number of 160 patients with CKD on regular hemodialysis have been enrolled in the current study irrespective of the underlying cause of their CKD. These patients used to attend a hemodialysis center in Baghdad on a regular basis, usually twice weekly from the 13th of January to the 21st of February 2019. All participants were assessed for serum calcium, phosphorus, and ALP in addition to their routine laboratory tests. The results were statistically evaluated using SPSS software version 23. The results reflect the relative difficulty in controlling these metabolic disturbances. Hyperphosphatemia has been detected in 66% of participants, hypocalcemia in 41%, while 35% of participants have shown elevated serum ALP. Furthermore, most participants have more than a single disturbance where the combined hypocalcemia and hypophosphatemia represent the major form of combined disturbance (35%). Despite the progression in modalities of treatment of CKD, including hemodialysis, the correction of its associated metabolic disturbances remains a challenge especially hyperphosphatemia and to lesser extent hypocalcemia.