Mineral-Bone Disorders in Chronic Hemodialysis Patients in Sub-Saharan Africa: Dakar Experience (Senegal West Africa)

Mineral-Bone Disorders in Chronic Hemodialysis Patients in Sub-Saharan Africa: Dakar Experience (Senegal West Africa)

LEMRABOTT Ahmet Tall2, KANE Yaya1 *, FAYE Maria2, FALL Khodia2, BANGOURA Mohamed1, FAYE Moustapha1, DIA Gueye Diatou3 , AIDARA Chérif Mohamadou1, CISSE M Moustapha4, SECK S Mohamed3, KA El Hadji Fary2, NIANG Abdou2, DIOUF Boucar2

1Nephrology and Hemodialysis Department – Orthopedic, Radiology Department, Peace Hospital, Assane Seck University, ZIGUINCHOR, Senegal; 2Nephrology and Hemodialysis Department, UCAD HALD, Dakar; 3Nephrology, Hemodialysis and internal medicine Department, CHR, St. Louis, Gaston Berger University; 4Nephrology and Hemodialysis Department, CHR, University of Thies

Global Journal of Urology and Nephrology

Introduction: Mineral bone disorders (BMD) are almost constant complications in chronic hemodialysis patients. The objective of our study was to determine the prevalence and profiles of BMD in chronic hemodialysis patients.

Patients and methods: This is a six-year descriptive and analytical retrospective study from January 1st, 2010 to December 31st, 2015, at the hemodialysis department of the University Hospital Center (CHU) Aristide Le Dantec. Were also included patients on chronic hemodialysis for at least 3 months, with at least one prescribed amount of parathyroid (PTH). For each included patient, the epidemiological, dialytic, diagnostic and therapeutic parameters were collected and analyzed.

Results: Over 86 patients, 71 (82.5%) had BMD. The average age was 48.92 ± 15.5 years old, with a sex ratio of 0, 65. Nephroangiosclerosis was the most frequent initial nephropathy (56.3%). The dialysis seniority was 5.2 ± 2.9 years old and 93% of patients profited from 3 sessions of 4 hours per week. Eleven patients (15.5%) had previous aluminum intoxication. Fifty-eight patients (81.6%) had secondary hyperparathyroidism, 12.6% had adynamic osteopathy (OA), and 1.4% had osteomalacia. In patients with secondary hyperparathyroidism, the average age was 48.6 ± 15 years old. 37.9% of these patients had articular pains, 22.4% had bone pains and 13.8% had spontaneous fractures. Eleven patients had hypocalcemia and only one patient had mild hypercalcemia. 46.5% of patients had normal phosphatemia; 29.3% had hypophosphatemia and 24.13% had hyperphosphatemia. Average PTH was 913.85 ± 331.65 ng/ml. 73% of patients had 25-OH-Vit D insufficiency; 72.7% of patients had high total PAL. Therapeutically, 91.4% of patients had been treated with calcium carbonate; 25.9% with a treatment based on non-calcium phosphorus chelators; 69% of patients received vitamin D and 15.5%, calcimimetic treatment. 22% of patients under medical treatment normalized their PTH. Parathyroidectomy was performed in 6.9% of patients. The average age in patients which presented an adynamic osteopathy was 50 ± 20 years old. The average PTH was 56.86 ng / ml, the average calcemia was 100 ± 4.3 mg/l, the average phosphatemia level was 59.5 ± 31.1 mg/l and the average vitamin D was 17, 42 ng / l. Twenty-three patients (32.4% of cases) had vascular calcifications. They were valvular in 25.4% of cases.

Conclusion: the BMD remain frequent in our hemodialysis center and dominated by the secondary hyperparathyroidism. A strict and early prevention strategy is necessary to control and delay the appearance of troubles= for a better quality of life for this population.

Keywords: Mineral bone disorders; Hyperparathyroidism; adynamic osteopathy; osteomalacia; hemodialysis; Sub-saharan Africa; Dakar.

Free Full-text PDF

How to cite this article:
LEMRABOTT Ahmet Tall, KANE Yaya, FAYE Maria, FALL Khodia, BANGOURA Mohamed, FAYE Moustapha, DIA Gueye Diatou , AIDARA Chérif Mohamadou, CISSE M Moustapha, SECK S Mohamed, KA El Hadji Fary, NIANG Abdou, DIOUF Boucar.Mineral-Bone Disorders in Chronic Hemodialysis Patients in Sub-Saharan Africa: Dakar Experience (Senegal West Africa)Global Journal of Urology and Nephrology, 2019, 2:12.


1. Levin A, Bakris GL, Molich M, et al. Prevalence of abnormal vitamin D serum, PTH, calcium and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007, 71: 31-38.
2. KDOQI. Clinical practice guidelines for bone metabolism and chronic kidney disease.
Am J Kidney Dis 2003, 42: S1-S 201.
3. KDIGO. Clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int 2009; 113: S1-130.
4. Block GA, Klassen PS, Lazarus JM et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15: 2208-18.
5. Foley RN, PS Parfrey, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32 (5): S112-9.
6. Left-handed A, Kessler M, Netter P. Osteoarticular complications of hemodialysis. Encycl Med Chir (Elsevier, Paris); Musculoskeletal System 1997; 14-276-A-10.
7. Vassalotti JA, Uribarri, Chen S-C et al. On the subject of the Early Kidney Assessment Program Investigators. in Mineral Metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis 2008, 51 (S2): S56-S68.
8. Jabrane M. Bone and mineral disorders in hemodialysis patients in the Nephrology-Hemodialysis department of Med VI University Hospital of Marrakech. Thesis Med. Marrakech, N ° 129, 2012.
9. Llach F, Felsenfeld A, Coleman M, et al. The natural course of osteomalacia dialysis. Kidney Int 1986; 29: 74-9.
10. Sherrard D, Hercz G, Pei Y, et al. The spectrum of bone disease in end-stage renal failure: An evolving disorder. Kidney Int 1993: 43: 436-42.
11. Seck SM, Dahaba M, Ka EF et al. Mineral and bone disease in black african hemodialysis patients: a report from senegal. Nephro urol Mon. 2012 ; 4 (4): 613-6.
12. Montasser D, Benyahia M, Zajjari Y et al. Surgical treatment of secondary hyperparathyroidism in chronic hemodialysis. Nephrol Ther 2011; 7 (5): 314.
13. Traoré D, Traore B, Nientao I et al. Epidemiological and clinical study of hyperparathyroidism secondary to chronic renal insufficiency in the nephrology and hemodialysis department of the G. point CHU. Ann Endocrinol 2015; 76 (4): 479-480.
14. Haddam A.E.M, Fedala N. S, Chentli F, D. Meskin. Secondary Hyperparathyroidism to renal kidney insufficiency: about a series of 15 patients. Ann Endocrinol 2015; 76: 476-477.
15. Guillaume Jean. Improve the pick-up charge of secondary hyperparathyroidism in the Maghreb: to finally remove these brown tumors. nephrol Ther; January 2016, 832.
16. Benabdellah N, Karimi I, Bentata Y et al. Phospho-calcic status in chronic hemodialysis in the Oriental Moroccan: evaluation of the adherence to the K / DOQI and KDIGO recommendations. Pan Afr Med J. 2013; 16:23
17. Gao P, Of Love P. Evolution of parathyroid hormone (PTH) assay-importance of circulating PTH immunoheterogeneity and its regulation. Clin Lab 2005 ; 51: 21-9.
18. Jean G, Vanel T, Terrat J.C. et al. Treatment of secondary hyperparathyroidism, resistant to conventional therapies, and tertiary hyperparathyroidism by cinacalcet: an effective strategy. Nephrol Ther 2010; 6 (2): 105-110.
19. Block GA. Martin KJ, Francisco Francisco et al. Cinacalcet for secondary hyperpathyroidism patients receiving hemodialysis. N. Engl J Med 2004: 350: 1516-25.
20. Mnif K, Toumi S, Mahfoudh H et al. Mineral and bone disorders in a population of chronic dialysis patients: assessment of adherence to the KDIGO remedy. nephrol Ther 2014; 10: 291-330.
21. Changsirikulchai S, Domrongkitchaiporn S, Sirikulchayanonta V et al. Renal osteodystrophy in Ramathibodi Hospital: Histomorphometry and Clinical Correlation. J Med Assoc Thai 2000; 83: 1223-1232.
22. Ndiaye N. Renal osteodystrophy: Epidemiological, clinical and therapeutic aspects at the hemodialysis center of the CHU Le Dantec. Thesis Med, Dakar, N ° 65, 2008.
23. Ka E.H.F, Seck S.M., Diakite F et al. Epidemiology of cardiac and vascular calcifications in hemodialysis patients at Aristide Le Dantec University Hospital. Nephrol Thér 2014; 10 (5): 294-295.
24. Cisse M, KA E.H.F, Tall Lemrabott A. Prevalence of fall of vitamin D in black-skinned patients on periodic hemodialysis in Dakar, Senegal: Thirty-seven cases. Med Sante Trop 2014; 24: 294-296.
25. Sayarlioglu et al. Prevalence and risk of factors of Valvular Calcification in Hemodialysis. Int J Kidney Dis 2013; 7: 129-34.
26. Strózecki P, et al. Cardiac valve calcifications and left ventricular hypertrophy in hemodialysis patients. Ren Fail. 2005; 27: 733-8.

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details).

This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.