Variants of the renal osteopathy in patients on continuous ambulatory peritoneal dialysis

Parathyroid function, calcium-phosphorus metabolism, bone structure and mineral density were studied in 104 patients (63 women and 41 men aged 18-71) with chronic renal failure (CRF) treated with continuous ambulatory peritoneal dialysis (CAPD) for 6-46 months. Patients were divided into 3 groups depending on plasma parathyroid hormone (PTH) concentration and activity of general alkaline phosphatase (AP): 1 - patients with supposed normal bone metabolism (PTH 150-450 pg/ml, AP 205 ± 49 un/l), 2 - those with secondary hyperparathyroidism (HPT, PTH > 450 pg/ml, AP 354 ± 171 un/l), and 3 - those with adynamic (low metabolic) bone disease (ABD, PTH < 150 pg/ml, AP 82 ± 25 un/l). Group 2 patients suffered from congenital and hereditary nephropathy significantly more often than other patients and had a higher rate of extremity bone fractures. Plasma phosphorus was equally increased in all patients; ionized calcium (Ca²⁺) concentration was decreased in patients of groups 1 and 2 and increased in patients of group 3. In all patients, the rate of osteopenic syndrome in distal forearm was 63.5%, in proximal femur - 59.3%, and in lumbar spine - 49.2%, and appeared to be equivalent in all skeletal areas. The rate of osteopenia in distal forearm and in proximal femur in patients of group 2 was significantly higher than in group 1 (p = 0.034). Group 2 patients were the most deficient of bone mass, especially in bones with cortical structure. In CRF patients receiving CAPD substitution therapy, the secondary hyperparathyroidism prevails (51.9%). These patients have the highest bone mineral deficiency and the highest rate of the latter (mainly in bones with cortical structure) which is a risk factor for bone fractures.

ренальная остеопатия, вторичный гиперпаратиреоз, адинамическая костная болезнь, постоянный амбулаторный перитонеальный диализ

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