ISSN: 2706-8870
Volume 7, Number 4 (2022)
Year Launched: 2016
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CORRELATION BETWEEN GLOMERULAR FILTRATION RATE WITH CALCIUM-PHOSPHATE PRODUCT LEVELS IN CHRONIC KIDNEY DISEASE

Volume 7, Issue 4, August 2022     |     PP. 224-231      |     PDF (176 K)    |     Pub. Date: June 24, 2022
DOI: 10.54647/cm32848    88 Downloads     4854 Views  

Author(s)

Rizki Primasari, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
Hasyim Kasim, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
Arifin Seweng, Department of Biostatistic, Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
Andi Muhammad Luthfi Parewangi, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
Endy Adnan, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
Syakib Bakri, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
Haerani Rasyid, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia

Abstract
Background: In chronic kidney disease (CKD) patients, calcium and phosphate homeostasis disorders occur. Decreased renal function will result in a decrease in phosphate excretion. In stage 3b CKD, the kidney is no longer able to compensate for phosphate burden adequately, and as a result hyperphosphatemia arises. The decline in renal function also causes calcitriol level to decline, which will be followed by undermined calcium absorption in the intestine. The application of calcium-phosphate binders and calcitrion in CKD will normalize phosphate and calcium levels in the blood. However, it can bring about hypercalcemia episodes. This research attempted to figure out the relationship between glomerular filtration rate (GFR) and calcium-phosphate (CaxP) product in CKD.
Methods: This is an observational study with a cross-sectional approach that involved 80 CKD subjects, distributed into stage 3 (n = 20), stage 4 (n = 20), non-dialysis stage 5 (n = 20), and dialysis stage 5 (n = 20) CKD patients at Wahidin Sudirohusodo Hospital and Unhas Hospital of Makassar from April to August of 2021. Phosphate levels were measured using ELISA kit (Immutopics). The results of the statistical tests conducted would be considered significant if p < 0.05.
Results: The CaxP product averages across stages were as follows: stage 3: 32.82 ± 10.77 mg2/dL2; stage 4: 32.95 ± 8.11 mg2/dL2; non-dialysis stage 5: 47.93 ± 21.28 mg2/dL2; and dialysis stage 5: 45.58 ± 24.74 mg2/dL2. The figures above showed that stage 3 was not significantly different from stage 4 (p = 0.986), but it was significantly different from non-dialysis stage 5 (p = 0.009). A significant difference was also found between stage 4 and non-dialysis stage 5 (p = 0.009). The proportion of subjects with high CaxP product (CaxP > 55 mg2/dL2) in CKD stage 3 was 5% (n = 1), in CKD stage 4 5% (n = 1), in non-dialysis stage 5 25% (n = 5), and in dialysis stage 5 35% (n = 7).
Conclusion: The lower the GFR the greater the CaxP product. The proportion of subjects with high CaxP product increased with the decrease in GFR.

Keywords
Phosphate; Calcium-Phosphate Product; Glomerular Filtration Rate; Chronic Kidney Disease

Cite this paper
Rizki Primasari, Hasyim Kasim, Arifin Seweng, Andi Muhammad Luthfi Parewangi, Endy Adnan, Syakib Bakri, Haerani Rasyid, CORRELATION BETWEEN GLOMERULAR FILTRATION RATE WITH CALCIUM-PHOSPHATE PRODUCT LEVELS IN CHRONIC KIDNEY DISEASE , SCIREA Journal of Clinical Medicine. Volume 7, Issue 4, August 2022 | PP. 224-231. 10.54647/cm32848

References

[ 1 ] Wen M, Li Z, Li J et al. Risk Factors for Primary Arteriovenous Fistula Dysfunction in Hemodualysis Patients: A Retrospective Survival Analysis in Multiple Medical Centers. Blood Purif. 2019; 1-7.
[ 2 ] Liyanage T, Ninomiya T, Jha V, et al. Worldwide Access to Treatment for End-Stage Kidney Disease: A Systematic Review. Lancet. 2015;385(9981):1975-1982.
[ 3 ] Van Der Vaart A, Yeung SMH, Van Dijk PR, et al. Phosphate and Fibroblast Growth Factor 23 in Diabetes. Clin Sci. 2021;135(14):1669.
[ 4 ] Hruska KA, Seifert M, Sugatani T. Pathophysiology of the Chronic Kidney Disease - Mineral Bone Disorder. Curr Opin Nephrol Hypertens. 2015;24(4):303-309.
[ 5 ] Sprague SM, Martin KJ, Coyne DW. Phosphate Balance and CKD–Mineral Bone Disease. Kidney Int Rep. 2021;6(8):2049-2058.
[ 6 ] Hoar S, Morton AR, Meers C, et al. A Multidisciplinary Approach to The Control of Calcium x Phospate Product in. Dial Transplant. 1999;28: 309-313.
[ 7 ] Ganesh SK, Stack AG, Levin NW, et al. Association of Elevated Serum PO4,Ca X PO4 Product, and Parathyroid Hormone with Cardiac Mortality Risk in Chronic Hemodialysis Patients. J am Soc Nephrol. 2001;12:2131-2138.
[ 8 ] Block GA, Shearon TE, Levin NW, et al. Association of Serum Phosphorus and Calcium X Phosphate Product With Mortality Risk in Chronic Hemodialysis Patients: A National Study. American Journal of Kidney Diseases. 1998;31(4):607-617.
[ 9 ] Yasin A, Liu D, Chau L, et al. Fibroblast Growth Factor-23 and Calcium Phosphate Product in Young Chronic Kidney Disease Patients: A Cross-Sectional Study. BMC Nephrol. 2013;14(39):1-8.
[ 10 ] Slawuta P, Kumiega E, Kopylowics AS, et al. An Attempt to use The Serum Concentration of the Phosphate (Pi) and the Ca x P Product As Markers of the Progression of Chronic Kidney Disease. Polish Journal of Veterinary Sciences. 2019;22(4):647–652.
[ 11 ] Ting IW, Yeh HC, Huang HC, et al. Joint Longitudinal Low Calcium High Phosphorus Trajectory Associates with Accelerated Progression, Acute Coronary Syndrome and Mortality in Chronic Kidney Disease. Scientific Reports. 2020;10:1-32.
[ 12 ] Isakova T, Wahl P, Vargas GS, et al. Fibroblast Growth Factor 23 is Elevated Before Parathyroid Hormone and Phosphate in Chronic Kidney Disease. Kidney Int. 2011;79(12):1370-1378.
[ 13 ] Fouque D, Vervloet M, Ketteler M. Targeting Gastrointestinal Transport Proteins to Control Hyperphosphatemia in Chronic Kidney Disease. Nephrol. 2018;78:1171-1186.
[ 14 ] Nadin C. Sevelamer as a Phosphate Binder in Adult Hemodialysis Patients: An Evidence-Based Review of Its Therapeutic Value. Core Evid. 2005;1(1):43-63.