Investigation of renal osteodystrophy among hemodialysis patients referring to Towhid Hospital, Sanandaj, Iran
DOI:
https://doi.org/10.22122/cdj.v2i1.52Keywords:
Renal Osteodystrophy, Hemodialysis, High Bone Turnover, Adynamic Bone DiseaseAbstract
BACKGROUND: Renal osteodystrophy is a major complication among dialysis patients that can lead to muscle weakness, and bone pain and fractures by minor trauma. In the present study, the frequency of these symptoms and status of blood markers among dialysis patients are discussed.
METHODS: In a crass-sectional study, blood sample was obtained from 82 hemodialysis patients for calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) level measurement. Radiography of the right hand was performed for 57 patients. Data analysis was performed via SPSS by using chi-square test, Fisher’s exact test, and Pearson correlation coefficient.
RESULTS: The prevalence of osteodystrophy among dialysis patients was 72% (59 patients), including 29 patients with high bone turnover and 30 patients with adynamic bone disease. Moreover, 24 patients (29.3%) were hypocalcaemic and 25 patients (30.5%) were hypercalcemic. In addition, 25 (30.5%) patients had hyperphosphatemia. In the present study, 82 patients, 40 male (48.8%) and 42 female (51.2%), were recruited. Patients’ mean age ± standard deviation was 55.77 ± 14.99. There was a relation between increase in age and adynamic bone disease (P = 0.004). Calcium level had a significant association with radiologic manifestation of renal osteodystrophy (P = 0.007). PTH levels had moderate correlation with ALP level (r = 0.55).
CONCLUSION: In the present study, there was a relation between age and adynamic bone disease; meaning that by increasing of age, the prevalence of adynamic bone disease also increased. There was a strong positive correlation between PTH and ALP.
References
Nouri Majelan N, Sanadgol H. Determining the diagnostic value level of alkaline phosphates in comparison with parathyroid hormone (PTH) of renal osteodystrophy for treatment with calcitriol in hemodialysis patients. Zahedan J Res Med Sci 2007; 8(4): 239-44. [In Persian].
Bagheri N, Falaknazi K, Zangi M, Safavi Naeini P, Bagheri M, Dehghan A, et al. Prevelance of adynamic bone disease among dialysis patients reffer to Tehran dialysis center. J Army Univ Med Sci I R Iran 2008; 5(4): 1423-7. [In Persian].
Bargman JM, Skorecki K. Chronic Kidney Disease. In: Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, et al., Editors. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: Mcgraw-hill; 2008.
Martin KJ, Gonzalez EA, Saltopolsky E. Renal Osteodystrophy. In: Brenner BM, Editor. Brenner & Rector's the kidney. Philadelphia, PA: Saunders; 2004. p. 2255-304.
K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42(4 Suppl 3): S1-201.
Martin KJ, Olgaard K, Coburn JW, Coen GM, Fukagawa M, Langman C, et al. Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy. Am J Kidney Dis 2004; 43(3): 558-65.
Afifi A, El-Sayed H, El-Setouhi M, Ahmed H, Khalifa N. Hyperphosphatemia among end-stage renal disease patients in developing countries: a forgotten issue? Hemodial Int 2005; 9(4): 409-15.
Drueke TB. Is parathyroid hormone measurement useful for the diagnosis of renal bone disease? Kidney Int 2008; 73(6): 674-6.
Ferreira A. Serum markers of bone turnover in the diagnosis of renal osteodystrophy. Rev Port Nefrol Hipert 2005; 19(Suppl 1): 57-71.
Kline MJ. Imaging in Osteomalacia and Renal Osteodystrophy. Medscape 2007; 357(3): 266-81.
Buargub MA, Nabulsi MF, Shafeh TA. Prevalence and pattern of renal osteodystrophy in chronic hemodialysis patients: a cross sectional study of 103 patients. Saudi J Kidney Dis Transpl 2006; 17(3): 401-7.
Galea I, Farrugia E. Biochemical indices of renal osteodystrophy in dialysis patients on the island of Malta. Int Urol Nephrol 2005; 37(2): 335-40.
Gupta V. Renal osteodystrophy and aluminium bone disease in patients with chronic renal failure. JK Practitioner 2003; 10(2): 107-11.
Hernandez D, Concepcion MT, Lorenzo V, Martinez ME, Rodriguez A, De BE, et al. Adynamic bone disease with negative aluminium staining in predialysis patients: prevalence and evolution after maintenance dialysis. Nephrol Dial Transplant 1994; 9(5): 517-23.
Lye WC, Lee EJ. Renal bone disease in patients on haemodialysis: biochemical and radiological assessment. Ann Acad Med Singapore 1992; 21(6): 760-4.
Santoso D, Yogiantoro M, Tomino Y. Osteodystrophy in Indonesian haemodialysis patients. Nephrology (Carlton) 2003; 8(5): 261-5.
Lugon JR, Andre MB, Duarte ME, Rembold SM, Cruz E. Effects of in-center daily hemodialysis upon mineral metabolism and bone disease in end-stage renal disease patients. Sao Paulo Med J 2001; 119(3): 105-9.
Shariati AR, Moojerloo M, Hessam M, Nasiri H, Roohi G. Parathyroid Hormon (PTH) in Hemodialysis Patients. Journal of Gorgan Bouyeh Faculty of Nursing & Midwifery 2007; (12): 27-32. [In Persian].
Lacativa PG, Franco FM, Pimentel JR, Patricio Filho PJ, Goncalves MD, Farias ML. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism. Sao Paulo Med J 2009; 127(2): 71-7.
Odenigbo UC, Ijoma CK, Ulasi I, Udeh AC, Ibeh CC. The prevalence of radiological markers of renal osteodystrophy in patients with chronic renal failure in Enugu. Niger J Clin Pract 2006; 9(2): 147-52.
Couttenye MM, D'Haese PC, Van Hoof VO, Lemoniatou E, Goodman W, Verpooten GA, et al. Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients. Nephrol Dial Transplant 1996; 11(6): 1065-72.
Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T. Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 1999; 33(2): 287-93.
