Studies of Bone Morphology, Bone Densitometry and Laboratory Data in Patients on Maintenance Hemodialysis Treatment

Abstract

Bone morphological parameters of renal osteodystrophy such as abundance of osteoid surface, osteoid seam width index, calcification fronts, osteoclast activity and trabecular bone volume were studied in 71 patients on maintenance hemodialysis and compared with bone densitometry, laboratory and clinical data. Increased osteoclast activity (hyperparathyroidism) was by far the most common bone morphological finding. Patients with chronic pyelonephritis or polycystic kidney disease had more than double the amount of osteoid than patients with chronic glomerulonephritis. The trabecular bone volume seemed to be increased in most patients in contrast to the cortical bone volume which was decreased, judged from bone densitometry and previously from X-ray. Despite that patients with polycystic kidney disease were older, their trabecular volume was larger than in patients with glomerulonephritis. The bone mineral content evaluated by bone densitometry was low in most patients, and more associated with bone morphological signs of osteomalacia than with secondary hyperparathyroidism. Serum phosphate (S-Po₄) and serum parathyroid hormone (S-PTH) seemed to discriminate better between osteomalacia and secondary hyperparathyroidism than serum alkaline phosphatase (S-Alk. phosph.), which was elevated in both groups. Patients who had been bilaterally nephrectomized were no more abnormal than other patients, and they had lower S-Alk. phosph. The abundance of osteoclasts was found to be a predictor of future development of clinical secondary hyperparathyroidism.

The Osteoporotic Effect of Arteriovenous Fistula on the Ipsilateral Upper Extremity in Hemodialysis Patients

“…As we found, Taal et al (33) and Huang et al (1), in their study of 151 hemodialysis patients, found a negative correlation between alkaline phosphatase and BMD, and between iPTH and BMD. In other studies, no significant relationship was found between iPTH and BMD (31,34). As did Sit et al (35) in their study of 70 hemodialysis patients, and Huang GS al.…”

Vitamin D and Renal Disease

“…In addition, there are differences in the microstructure in different diseases. In idiopathic osteoporosis, both cortical and cancellous bone volumes decrease, whereas in hemodialysis patients the cortical compartment is reduced, but the cancellous one is increased [44]. Bone volume is classified as low, normal, and high [42].…”

“…OM in CKD prevalence is decreasing significantly since 1995 and currently is bordering at 0%. However, AD is getting more common than all other subtypes of renal osteodystrophy, with prevalence peaking to 40% [44].…”

Evaluation of Bone Mineral Density in Hemodialysis Patients

“…Literatürde bizim çal›flmam›zda oldu¤u gibi KMY de¤erleri ile yafl ve diyaliz süresi aras›ndaki iliflkiyi a盤a ç›karama-yan baflka araflt›rmalar da bulunmaktad›r (8,11,(18)(19)(20). Bunun nedeni hasta say›s›n›n az olmas›n›n yan› s›ra yafl ve diyaliz sürele-ri de¤erlerinin genifl aral›¤a da¤›lm›fl olmas› olabilir.…”

“…Baz› çal›flmalarda, beklenildi¤i üzere, alkalen fosfataz ve iPTH ile KMY de¤erleri aras›nda negatif korelasyon oldu¤u bildirilmifltir (9,11). Di¤er çal›flmalarda ise bizim çal›flmam›zda oldu¤u gibi iPTH ile KMY aras›nda herhangi bir iliflki saptanmam›flt›r (8,(23)(24)(25)(26)(27). Bunun nedeni bu çal›flmalarda hasta say›s›n›n az olmas› ya da serum iPTH ölçüm yöntemlerinin farkl› olmas› olabilir.…”