Impacto de las alteraciones del metabolismo mineral óseo en la morbilidad y mortalidad en los pacientes con enfermedad renal crónica en diálisis, periodo 2020 - 2025.

Abstract

Introduction: bone mineral metabolism disorders are frequent and severe complications in pediatric patients with chronic kidney disease, particularly in advanced stages. These alterations, grouped under the term mineral and bone metabolism disorders associated with chronic kidney disease, include hyperphosphatemia, hypocalcemia, secondary hyperparathyroidism, and decreased active vitamin D. Objective: evaluate the impact of bone mineral metabolism disturbances on the morbidity and mortality of patients with chronic kidney disease on dialysis. Materials and Methods: as materials and methods, an observational, cross-sectional, and retrospective study was conducted in children with stage V chronic kidney disease on renal replacement therapy with peritoneal dialysis and hemodialysis, from the nephrology dialysis program of hospital del niño Dr. Francisco De Icaza Bustamante, between January 2020 and December 2025. Results: Phosphorus and parathyroid hormone were found elevated in more than half of the measurements, while calcium remained within normal range; hyperphosphatemia was significantly associated with cardiovascular complications (p=0.0252), and secondary hyperparathyroidism showed association with both cardiovascular complications (p=0.0436) and growth and development alterations (p=0.0451). Hypercalcemia showed no association with any complication. Mortality was 13.0%, with survival declining from the third year on dialysis onward, and parathyroid hormone showed a significant increase with time on dialysis (p<0.0001). Conclusion: Mineral bone metabolism status showed no differences between patients on peritoneal dialysis and those on hemodialysis, although the hemodialysis group was small within the sample. Mineral bone metabolism disorders were frequent; hyperphosphatemia and secondary hyperparathyroidism were associated with cardiovascular complications, and the latter was also associated with growth and development alterations, while parathyroid hormone increased progressively with time on dialysis, highlighting the importance of its continuous monitoring.