Association of markers of bone mineral disease and left ventricular hypertrophy in patients of chronic kidney disease

Abstract

Background. Chronic kidney disease (CKD) is an epidemic health problem responsible for an increase in morbidity and mortality secondary to various complications, especially cardiovascular events. Previous studies have suggested that biochemical markers of metabolic bone disease (MBD) are associated with an increase in cardiovascular events by causing left ventricular hypertrophy (LVH). Therefore, the present study aimed to evaluate the association between LVH and CKD-MBD markers as a major predictor for cardiovascular disease (CVD) in CKD patients. Materials and Methods. A single-center, cross-sectional, observational study was carried out at a tertiary care center. A total of 50 CKD patients, stages 3-5, not on dialysis, were included. Demographic details, clinical 
history, laboratory investigations and echocardiography were obtained. The presence of LVH was determined on the basis of echocardiography, and it was associated with CKD stages and biochemical markers, including CKD-MBD markers. Results. Seventy-two percent of CKD patients had LVH. The proportion of patients with LVH significantly increased with a declining estimated glomerular filtration rate (eGFR). Hypertension was considerably higher in patients with LVH (63.89%). Significant association of LVH was seen with serum creatinine, corrected calcium, phosphorus, total cholesterol, fibroblast growth factor 23 (FGF-23), vitamin D, intact parathyroid hormone (iPTH), eGFR, left ventricular mass index (LVMI) and ejection fraction (p-value < 0.05). On multivariate regression, FGF-23 had a significant positive correlation with LVH (p-value < 0.05, odds ratio > 1). A significant positive correlation was observed between LVMI and systolic blood pressure, serum creatinine, phosphorus, total cholesterol, iPTH, and FGF-23. A significant negative correlation was seen with LVMI and hemoglobin, corrected serum calcium, albumin, eGFR, vitamin D and ejection fraction. Conclusion. The present study shows CKD-MBD markers, including serum calcium, phosphorous, vitamin D, iPTH and FGF-23, are significantly associated with LVH. FGF-23 is an independent predictor of LVH. The present study also demonstrates that CKD-MBD biochemical markers are reliable for screening CVD in CKD patients.