| Effect of Low Calcium Dialysate on Bone Markers in Hemodialysis Patients
who May Have Adynamic Bone Disease
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| 저칼슘 투석액의 사용이 무력성 골질환이 의심되는
혈액투석 환자의 골표지자에 미치는 영향
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| 전재현,윤혜진,강현재,김인식,정재권,황중하,김의현,김용림*,조동규*,김성호 |
| 대구 파티마 병원 내과, 경북대학교 의과대학 내과* |
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| Abstract |
Background
Recently, the incidence of adynamic renal osteodystrophy (ARO) has been increased. Relative hypoparathyroidism induced by positive calcium (Ca) balance is considered to be one of the major causes of ARO. The use of Ca-containing phosphate binders, vitamin D, and relatively high Ca amount in dialysate are the main causes of positive Ca balance. This study was prospectively designed to evaluate the reversibility of secondary hypoparathyroidism, the hallmark of ARO, with the use of low Ca dialysate.
Methods
Twenty five patients who presumably had ARO [serum intact parathyroid hormone (iPTH) concentration ≤ 100 pg/mL] were recruited. They have been stable for more than 3 months with relatively high (1.5 mmol/L) Ca dialysate treatment and then treated with low Ca (1.25 mmol/L) dialysate for 3 months. Bone metabolic parameters, including serum iPTH and alkaline phosphatase (ALP) levels were measured at baseline and every month. Twenty one patients could finish the study. Six of them were male and 15 female. The causes of end stage renal disease were as follows; diabetes mellitus 7, chronic glomerulonephritis 7, hypertension 4, polycystic kidney disease 2 and unknown 1. The mean age was 60±11 years and the mean duration of hemodialysis prior to the study was 40±41 months.
Results
The iPTH (44.1±29.5 pg/mL to 71.5±49.0 pg/mL, p<0.01) and ALP levels (124.1±41.6 IU/L to 158.6± 40.7 IU/L, p<0.01) were significantly increased after 3 months use of low Ca dialysate. The corrected Ca levels (2.49±0.24 mg/dL to 2.32±0.17 mg/dL, p<0.05) and the number of patients whose corrected Ca concentration was more than 2.5 mmol/L (11 to 3, p=0.01), were both decreased after 3 months of study.
Conclusion
Low Ca dialysate may be effective for the treatment of hypoparathyroidism of ARO in hemodialysis patients. |
| Key Words:
Low Ca dialysate, Hemodialysis, Hypoparathyroidism, Adynamic renal osteodystrophy, Hypercalcemia |
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