Mineral-bone disorders in chronic hemodialysis patients in sub- saharan africa: dakar experience (senegal west africa)

Abstract

Introduction: Mineral bone disorders (BMD) are almost constant complications in chron-ic hemodialysis patients. The objective of our study was to determine the prevalence and profiles of BMD in chronic hemodialysis patients. Patients and methods: This is a six-year descriptive and ana- lytical retrospective study from January 1st, 2010 to December 31st, 2015, at the hemodialysis department of the University Hos- pital Center (CHU) Aristide Le Dantec. Were also included pa- tients on chronic hemodialysis for at least 3 months, with at least one prescribed amount of para-thyroid (PTH). For each included patient, the epidemiological, dialytic, diagnostic and therapeutic parameters were collected and analyzed. Results: Over 86 patients, 71 (82.5%) had BMD. The aver- age age was 48.92 ± 15.5 years old, with a sex ratio of 0, 65. Nephroangiosclerosis was the most frequent initial nephropathy (56.3%). The dialysis seniority was 5.2 ± 2.9 years old and 93% of patients profited from 3 sessions of 4 hours per week. Eleven patients (15.5%) had previous aluminum intoxica-tion. Fifty-eight patients (81.6%) had secondary hyperparathyroidism, 12.6% had ady-namic osteopathy (OA), and 1.4% had osteomalacia. In pa- tients with secondary hy-perparathyroidism, the average age was 48.6 ± 15 years old. 37.9% of these patients had articular pains, 22.4% had bone pains and 13.8% had spontaneous fractures. Eleven patients had hypocalcemia and only one patient had mild hypercalcemia. 46.5% of patients had normal phosphatemia; 29.3% had hypophosphatemia and 24.13% had hyper-phospha- temia. Average PTH was 913.85 ± 331.65 ng/ml. 73% of patients had 25-OH-Vit D insufficiency; 72.7% of patients had high total PAL. Therapeutically, 91.4% of patients had been treated with calcium carbonate; 25.9% with a treatment based on non-calcium phosphorus chelators; 69% of patients received vitamin D and 15.5%, calcimimetic treatment. 22% of patients under medical treatment normalized their PTH. Parathyroidectomy was performed in 6.9% of patients. The average age in patients which presented an adynamic osteopathy was 50 ± 20 years old. The average PTH was 56.86 ng / ml, the average calcemia was 100 ± 4.3 mg/l, the average phosphatemia level was 59.5 ± 31.1 mg/l and the average vitamin D was 17, 42 ng / l. Twenty-three patients (32.4% of cases) had vascular calcifications. They were valvular in 25.4% of cases. Conclusion: the BMD remain frequent in our hemodialysis center and dominated by the secondary hyperparathyroidism. A strict and early prevention strategy is necessary to control and delay the appearance of troubles= for a better quality of life for this population.