Prevalence and pattern of Mineral Bone Disorders in patients with end-stage renal disease and the impact of diabetic status and type of phosphate binders on these disorders

Background: Mineral and bone disorders are considered one of the most common disorders affecting renal patients that are associated with great mortality and morbidity. Also, diabetes as a metabolic disorder could affect the bone mineralization per se. As hyperphosphatemia is the key factor of such a pathogenic process, most management is directed toward lowering phosphate levels and correcting such metabolic derangements, one of them is the use of phosphate binders. The aim is to measure the prevalence of bone mineral disorders in patients with end-stage renal disease on regular hemodialysis in diabetics and non-diabetics and to assess the pattern of bone disorders and the effect of the use of different types of phosphate binders on the assessed biochemical markersMethods: a cross-section study included 116 patients with end-stage renal disease on regular hemodialysis (26 due to diabetes, 90 due to other causes), 50% used calcium-based phosphate binders and 50% used non-calcium binders. the prevalence and pattern of bone mineral disorders and the effect of different binders on biochemical markers are studied.Results: bone mineral disease is prevalent in 59.6% (low and high bone turnover 38.8%,20.7% respectively), with the same pattern in diabetics (low and high bone turnover 30.8%, 23.1% respectively). A significantly lower phosphate level and intact parathyroid hormone in non-calcium phosphate binder users (p=0.013, 0.039, respectively).Conclusion: low bone turnover is more prevalent in renal patients with hemodialysis and patients with diabetic nephropathy. Non-calcium-based phosphate binders are associated with lower phosphate and parathyroid levels with less risk of hypercalcemia.