Endocrine Abstracts

Objectives: To compare the diabetic (DM) (n=124) and non diabetic (nonDM) (n=63) patients on haemodialysis (HD) in terms of renal bone disease (RBD) control.

Methods: Retrospective case-note review of 187 HD patients. The National Kidney Foundation guidelines for chronic kidney disease stage 5 (CKD-5) were used, with target levels for parathormone (PTH) 16.5–33 pmol/l, calcium 2.1–2.35 mmols/l and phosphate 1.78 mmols/l.

Results: In the nonDM and the DM group, hyperphosphataemia was noted in 33.9 and 33.3% respectively, high PTH in 55.6 and 55.5%, and hypercalcaemia in 58 and 62%. In the nonDM population, 92.7% was treated with phosphate regulating drugs, such as oral vitamin D(69.3%),calcium based phosphate binders (CBPB) (53.2%) and sevelamer (17%). 44.35% of the nonDM group were on multi-drug therapy (two or more medications). Amongst the nonDM patients on monotherapy, 37% showed hyperphosphataemia, 49% high PTH and 55% high calcium, whereas the corresponding figures in patients on multi-drug therapy were 31.5, 61 and 66.6%.

In the DM group, 98.4% were on treatment for RBD, including vitamin D (73%), CBPB (62%) and sevelamer (19%). CBPB and vitamin D were equally used as monotherapy, while 52.4% of the DM patients were on 2 or more medications. In the multi-drug subgroup, 36.3% had hyperphosphataemia, 63.6% showed hypercalcaemia and 63.6% high PTH. In diabetic patients on monotherapy 20.7% had hyperphosphataemia,62% hypercalcaemia and 44.8% high PTH.

Conclusions: More than 90% of the HD population was on treatment for RBD and more than half had high calcium and PTH. Hyperphosphataemia was found in more than 30% of the HD patients on treatment. No significant difference was noted in phosphate, calcium and PTH levels between the nonDM and DM groups. The most commonly used medication in both groups was vitamin D. CBPB were used more frequently in the DM group. Interestingly, both in the nonDM and DM groups multi-drug therapy was associated with worse RBD control most likely because of the severity of the underlying disease.