Author/Authors :
ALBAZ, WALAA F. Al-Azhar University - Faculty of Medicine for Girls - Department of Internal Medicine, Egypt , NAFEE, EMAD Al-Azhar University - Faculty of Medicine for Girls - Department of Internal Medicine, Egypt , AHMED, LAMYAA I. Al-Azhar University - Faculty of Medicine for Girls - Department of Internal Medicine, Egypt , MOHMMED, RAGAA R. Al-Azhar University - Faculty of Medicine for Girls - Department of Internal Medicine, Egypt , KHATTAB, SAHAR S. Al-Azhar University - Faculty of Medicine for Girls - Department of Clinical and Chemical Pathology, Egypt , GABER, HIATHAM A. Wady El-Nile Hospital - Department of Nephrology and Renal Transplantation, Egypt
Abstract :
The plasma level of Osteoprotegerin (OPG) in combination with intact parathyroid hormone (iPTH) can be used as a marker for noninvasive diagnosis of CKD-MBD (Chronic Kidney Disease- Metabolic Bone Disease) in hemodialysis and predialysis patients.Objective: The aim of the study to assess the level of (OPG) in end stage renal disease, and whether there is significant correlations between, iPTH, serum calcium, phosphorus, CaxPh product, CRP, cholesterol, triglycerides and BMD (bone mineral density) in Patients on Hemodialysis and Predialysis stages (stage 3 4).Methods: Eighty one individuals were included in the study, classified into three groups Group A: 41 patients chronic kidney disease stage 5, Group B: 30 patients as pre-dialysis group (stage 3 4 CKD), Group C: Control group, consists of 10 healthy volunteers who are age and sex matched to the patients. All groups were subjected to the following: Full Medical history, full clinical examination, total serum Calcium and total serum Phosphorus, C-Reactive Protein (CRP), total serum cholesterol and triglycerides, intact parathyroid hormone (iPTH), serum Osteoprotegerin (OPG) and measurement of BMD with DEXA at lumbar spine L2-L4.Result: There was highly statistical significant increase in OPG level measured for groups A,B compared with group C. In dialysis group, OPG showed a non significant correlation with calcium, but it showed a significant positive correlation with age. On the other hand, it showed a high significant positive correlation with iPTH, Phosphorus, CaxPh product, CRP, Cholesterol, Triglycerides, and high significant negative correlation with BMD. In pre-dialysis group, OPG showed a non significant correlation with CaxPh product, CRP, Triglycerides and stage 3 4 of CKD. But it showed a high significant positive correlation with age, iPTH, Phosphorus. On the other hand, it showed a significant negative correlation with Cholesterol While a highly significant negative correlation was obtained with corrected serum calcium, and high significant negative correlation with BMD.Conclusion: We conclude that the osteoprotegerin increased in patients with CKD even in the stages before the start of renal replacement therapy. We strongly suggest the annual determination of this marker as part of the biologic flow-up of these patients. Serum OPG may be a useful biomarker for early diagnosis of CKD-MBD, also OPG or one of its derivatives may be used in the future in the treatment of CKD-MBD.
