Avaliação dos parâmetros bioquímicos minerais e ósseos em pacientes com doença renal crônica e sua relação com fatores de risco, tempo de progressão e tratamento da doença

Abstract

Chronic kidney disease (CKD) is a health condition of great relevance due to its clinical implications and impact on patients' quality of life. The progression of the disease significantly influences the mineral and bone metabolism of patients, as alterations in these parameters are strongly associated with clinical complications such as renal bone disease, vascular calcification, and adverse cardiovascular outcomes. Additionally, hemodialysis therapy, often used for patients with advanced CKD, can affect mineral and bone balance as well as other associated risk factors, increasing clinical complexity and management. The study was approved by Ethics Research Committee opinion number 6.055.977 and aimed to analyze the relationships between mineral biochemical parameters, risk factors associated with mineral and bone disorders, time of diagnosis, and treatment in patients with Chronic Kidney Disease (CKD) to understand the interaction of these elements and identify possible patterns or associations that may influence the prognosis and progression of the disease. A questionnaire was administered to 170 patients from a nephrology outpatient clinic. The questionnaire addressed issues involving personal data (name, age, sex, weight, height, waist circumference, calf circumference), clinical data (time of diagnosis and time of hemodialysis), and risk factors such as smoking, diabetes, and hypertension. Serum calcium, phosphorus, and parathyroid hormone (PTH) values from 89 patients were used for biochemical parameter evaluation. Demographic, clinical, and anthropometric characteristics were analyzed. Regarding serum levels of calcium, phosphorus, and PTH, individuals were categorized and evaluated for the influence of risk factors and their association with biomarkers, including their relationship with diagnosis and hemodialysis time, as well as correlations of these levels with clinical data. As a result, a high prevalence of advanced CKD was identified, particularly among males. Systemic arterial hypertension (SAH) and diabetes mellitus (DM) were the most frequent comorbidities. It was observed that diabetic patients showed lower PTH levels compared to those who did not have this condition, and patients undergoing hemodialysis presented higher serum phosphorus levels compared to those undergoing conservative treatment. SAH was more present in cases of hyperphosphatemia and also associated with PTH alterations; additionally, it was found that the average age and Body Mass Index (BMI) were higher in patients with hypocalcemia compared to other alterations. Regarding the influence of diagnosis and hemodialysis time on biomarker levels, it was observed that only serum PTH concentration varied according to diagnosis and hemodialysis time. Furthermore, hemodialysis time positively correlated with both phosphorus levels (r = 0.3138; p = 0.0299) and PTH levels (r = 0.2988; p = 0.0391), while diagnosis time and BMI correlated positively only with PTH levels (r = 0.3451; p = 0.0009; and r = 0.2381; p = 0.0239), and age correlated negatively with phosphorus levels (r = -0.2365; p = 0.0248). Thus, the study enabled the delineation of the demographic, clinical, and anthropometric profile of CKD patients, as well as highlighted relationships between mineral biochemical parameters and risk factors associated with bone and mineral disorders. These results have the potential to guide more effective prevention and treatment strategies aimed at improving the quality of life and mitigating bone and mineral complications in CKD patients.