J Korean Med Sci.  2017 Feb;32(2):240-248. 10.3346/jkms.2017.32.2.240.

Chronic Kidney Disease-Mineral Bone Disorder in Korean Patients: a Report from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

• Kim CS
• Bae EH
• Ma SK
• Han SH
• Lee KB
• Lee J
• Oh KH
• Chae DW
• Kim SW
• Representatives of the KNOW-CKD Study Group

• KMID: 2364167
• DOI: http://doi.org/10.3346/jkms.2017.32.2.240

Abstract

This study examined the characteristics of biochemical parameters, bone diseases, and vascular calcification in Korean patients with chronic kidney disease (CKD) not yet on dialysis. Serum levels of fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 (25D), and 1,25-dihydroxyvitamin D3 (1,25D); lumbar spine, total hip, and femur neck bone mineral densities; and brachial-to-ankle pulse wave velocity (baPWV) representing vascular calcification were measured at baseline for 2,238 CKD patients in the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Increases in serum FGF23 and iPTH preceded changes in serum calcium and phosphate, similar to Western populations. However, the 25D and 1,25D levels decreased earlier than serum FGF23 or iPTH increased, with a decreased estimated glomerular filtration rate (eGFR) in Korean CKD patients. Vitamin D deficiency occurred in 76.7% of patients with CKD stage 1. Bone mineral densities were lowest in CKD stage 5 (lumbar spine, −0.64 ± 1.67; total hip, −0.49 ± 1.21; femur neck, −1.02 ± 1.25). Osteoporosis was more prevalent in patients with higher CKD stages. The mean baPWV, abdominal aortic calcification (AAC), and coronary calcium score also increased, with declined eGFR. In conclusion, a decline in serum vitamin D levels was observed in early CKD stages before significant increases of FGF23 and iPTH in the Korean CKD population compared with that in Western populations. Increased bone disease and vascular calcification occurred in early-stage CKD.

Keyword

Chronic Kidney Disease; Bone Diseases; Vascular Calcification; Korean

MeSH Terms

Bone Density
Bone Diseases
Calcifediol
Calcitriol
Calcium
Cohort Studies*
Dialysis
Femur Neck
Fibroblast Growth Factors
Glomerular Filtration Rate
Hip
Humans
Kidney*
Osteoporosis
Parathyroid Hormone
Pulse Wave Analysis
Renal Insufficiency, Chronic*
Spine
Vascular Calcification
Vitamin D
Vitamin D Deficiency
Calcifediol
Calcitriol
Calcium
Fibroblast Growth Factors
Parathyroid Hormone
Vitamin D

Figure

• 

  Fig. 1 Distributions of biochemical parameters of mineral metabolism in relation to CKD stages. (A) Calcium and phosphate. (B) iPTH, 25D, and 1,25D. Error bars denote standard deviation (SD). CKD = chronic kidney disease, iPTH = intact parathyroid hormone, 25D = 25-hydroxyvitamin D3, 1,25D = 1,25-dihydroxyvitamin D3. *P < 0.05 for trend between stages.

• 

  Fig. 2 The prevalence of serum FGF23 excess (FGF23 > 100 RU/mL), secondary hyperparathyroidism (iPTH > 65 pg/mL) and vitamin D deficiency (25D < 20 ng/mL) in relation to CKD stages. FGF23 = fibroblast growth factor 23, iPTH = intact parathyroid hormone, 25D = 25-hydroxyvitamin D3, CKD = chronic kidney disease. *P < 0.05 for trend between stages.

• 

  Fig. 3 The prevalence of osteoporosis based on femoral neck BMD in relation to CKD stages. BMD = bone mineral density, CKD = chronic kidney disease. *P < 0.05 for trend between stages.

• 

  Fig. 4 Values of baPWV within (A) each CKD stage and (B) according to primary renal disease type. CKD = chronic kidney disease, baPWV = brachial-to-ankle pulse wave velocity, GN = glomerulonephritis, DN = diabetic nephropathy, HTN = hypertensive nephropathy, PKD = polycystic kidney disease. *P < 0.05 for trends between stages. Error bars = standard deviation (SD).

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