EVALUATION OF SOME MINERALS AND BIOCHEMICAL PARAMETERS IN PATIENTS UNDERGOING HAEMODIALYSIS IN NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL, NNEWI.

AUTHOR: EZEONYEBUCHI JOY NKIRUKA

 DEPARTMENT: CHEMICAL PATHOLOGY

AFFILIATION: NNAMDI AZIKIWE UNIVERSITY, AWKA

Haemodialysis is the most common form of treatments for end stage renal disease(ESRD), and is associated with considerable morbidity and mortality. This cross sectional study was conducted to determine the biochemical changes in haemodialysis patients by accessing their minerals and also to identify any biomarker that may lead to renal osteodystrophy in these patients. A total of 100 participants were used for this study. 50 haemodialysis subjects grouped into predialysis, 0-hour after dialysis and 1- hour after and 50 apparently normal subjects. They were age matched into 21-30, 31- 40, 41-50, 51-60, 61-70. The minerals assayed were Na+, K+, Cl-, HCO3-, Ca2+, PO4 2-, Se, Zn, Cu and Co. PTH was also analysed. Electrolytes were assayed by ion selective electrode, trace elements by atomic absorption spectroscopy, Ca2+ by colorimetric method, PO4 2+ by UV method and PTH by enzyme immunoassay method. The results were subjected to statistical analysis (SPSS ver.17) and comparison made using student’s t-test and ANOVA at P-value<0.05. The mean values of Na+, Cl-, HCO3- were significantly lower in haemodialysis patients (Na+:127.92+6.24mmol/l, P=0.00; Cl-: 88.84+6.14mmol/l,P=0.00; HCO3-:16.46+2.97mmol/l,P=0.00) compared with the controls (Na+: 141.28+2.51mmol/l; Cl- 100.32 + 2.28mmol/l;HCO3-24.64 +1.83mmol/l). Also, the mean value of K+ was significantly higher in dialysis subjects (4.21±0.88mmol/l, P=0.041) when compared with the control subjects (3.92±0.34mmol/l). Calcium level was significantly low in dialysis subjects (8.41±0.72mg/dl, P=0.000) as compared with the controls (9.65±0.50mg/dl). Phosphate on the other hand was significantly higher in dialysis group (4.35±1.06mg/dl, P=0.00) when compared with the controls (3.58±0.47mg/dl). However, the mean value of PTH in dialysis subjects was (165.32±154.90ng/l) and it was significantly higher than the control (P=0.00) (38.2±12.18ng/l). Zn and Se mean levels were significantly lower in dialysis subjects (79.33±16.27μg/dl, P=0.02 and 6.67±1.43μg/dl, P=0.00) compared with the control (88.97±9.77μg/dl and 9.00±2.48μg/dl) respectively. Cu showed a significantly high mean value in the dialysis (117.54±14.69μg/dl, P=0.01) when compared with the control subjects (108.50±15.49μg/dl). There was no significant difference in the mean level of Co (0.03±0.01μg/dl, P=0.26) when compared with the controls (0.04±0.00). Comparison of the mean levels of these minerals between male and female counterparts among the different dialysis groups showed no significant differences. More so, no significant difference was observed when the mean levels of these minerals were compared between 1-hour after dialysis and immediately after dialysis group. In conclusion, this study showed that there is a marked reduction in the zinc and selenium status in haemodialysis patients. Also there appears to be prevalence of renal osteodystrophy (ROD) in our institution probably because of inadequate monitoring of these patients. Decrease in these minerals may be the cause of high risk of infection and oxidative stress observed in these patients. The prevalence of ROD in these patients may result in cardiovascular death. Therefore, I recommend that these minerals should be assessed from time to time so as to monitor these biochemical changes observed in these patients.

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