Background: Calcium, phosphate Magnesium is minerals that are important for health, they help to build strong bones and teeth, and also play a role in cell and nerve function. Patients with chronic kidney disease (CKD) have marked disruption in bone and mineral metabolism resulting in a complex disorder that has been termed CKD-mineral bone disorder (CKD-MBD). Chronic Kidney Disease (CKD) nowadays becomes an emerging condition with increasing morbidity and mortality. However, our understanding of calcium phosphorus and magnesium balance throughout the stages of chronic kidney disease is limited. It is associated with complex disturbances in calcium, phosphorous and magnesium levels especially in stage 4 and 5 of CKD. Both negative and positive balance have important implications in patients with chronic kidney disease, where negative balance may increase risk of osteoporosis and fracture and positive balance may increase risk of vascular calcification and cardiovascular events. Thus study is undertaken to find out role of these marker in serum as an early diagnostic and prognostic marker of CKD but also assess the severity of stage 4 and 5 of CKD in correlation with eGFR. Aim and Objective: The main aim of this study is to compare the levels of serum, calcium, phosphorous, and magnesium levels in stages 4 and 5 of chronic kidney disease patients and compared with healthy individuals. To also to find out their association with eGFR, which is important predictor disease progression of CKD. Materials and Method: Duration based case control study which includes50 CKD patients in stage 4 and 5, attending Nephrology out- patient department as cases and 50 healthy individuals between the age group 21 to 78 were included as control in study. Study was conducted at vydehi institute of medical sciences and RC. Serum levels of Calcium, Phosphorous, and Magnesium were measured; eGFR was calculated by CKD –MDRD Formula. All measured variables were correlated with e GFR and compared between cases and controls. Statistical Analysis: Statistical analysis is done by SPSS Software. Results: The results are presented as a mean ± SD and 'p' value of less than 0.05 is considered as significant. eGFR (ml/min) cases mean and SD 14.12±,10.72 102.97±27.4 6 in control, Serum Creatinine (mg/dl) 7.04±5.34 in cases 0.84±0.20 in control, Serum Calcium (Ca) (mg/dl) 8.11±1.09in cases and in control 9.31±0.42,Serum Phosphrous (P) (mg/dl) 4.86±1.83 in CKD 3.27±0.54 .Ca x P Ionic Product 38.99±13.77 in cases 30.46±5.03.Serum Magnesium (Mg) (mg/dl) 2.00±0.51 in CKD 1.91±0.30 Conclusion: Result of our study showed Hypocalcemia, Hyperphosphatemia and Hypomagnesemia. Hypocalcemia and Hyperphosphatemia due to failing kidney results in secondary hyper parathyroidism in advanced Chronic Kidney Disease. Hyperphosphatemia is a well-known risk factor for mortality in ESRD patients, which aggravates with low Mg. A low Mg in CKD is also associated with several complications such as hypertension, and vascular calcification. Hypomagnesemia is associated with an increased risk for both cardiovascular disease (CVD) and non-CVD mortality. Thus these parameters are used as early diagnostic and prognostic markers in CKD. Also predictors of poor out come and indicator of treatment with dialysis.
