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[Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L].
Nefrologia. 2001 Sep-Oct; 21(5):485-92.N

Abstract

The existence of a low-bone turnover, non-aluminium related, has been more prevalent in recent years. Factors involved include the increasing number of older and diabetic patients initiating dialysis. Also higher intake of calcium salts and the widespread use of vitamin D derivates may play a role. Demonstration of low PTH secretion allows the recognition of the group of patients with special risk of adynamic bone disease. Little can be done to improve bone remodelling apart from correct management of risk factors previously mentioned. A decrease in dialysate calcium concentration can act in this way, but the long term effect of this procedure on bone mineral density has scarcely been established. The aim of this study was to evaluate the long term effect of lowering the dialysate calcium concentration from 3.5 to 3 mEq/L on bone mass and PTH activity in patients with hypoparathyroidism. We studied 19 patients with PTH < 120 pg/ml and calcemia between 8.5 and 10.5 mg/dl, without aluminium intoxication. Blood levels of Ca, P, alkaline phosphatase, aluminium, iPTH and dialysis doses were measured every 4 months during the two years of follow-up. Phosphate binders were closely monitored. Also calcium dietary feeding was measured by a 5-day dietetic registry at the beginning and 6 and 12 months later. Bone mineral density was assessed by quantitative computed tomography of the distal radius initially and after 18 months. PTH values had significantly increased from the first measurement (from 46 +/- 33 to 97 +/- 68 four months later). At the end of follow up, 8 patients (42%) had reached the objective of maintaining a PTHi above 120 pg/ml, while 11 had not reached it (3 were previously parathyroidectomized and two were diabetic). Only one patient has developed an exaggerated PTH response that has been controlled with oral vitamin D. No bone mineral loss was observed during the follow up. In conclusion, the use of a 3 mEq/l dialysate calcium may improve hypoparathyroidism in a substantial number of patients, avoiding the untoward effect that lower calcium concentration has on bone mineralization.

Authors+Show Affiliations

Servicio de Nefrología, Corporació Parc Taulí, Sabadell, Barcelona.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

spa

PubMed ID

11795018

Citation

Almirall, J, et al. "[Assessment of Long-term Bone Metabolism in Patients With Relative Hypoparathyroidism After Changing the Calcium Concentration of the Dialyzate to 3mEq/L]." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, vol. 21, no. 5, 2001, pp. 485-92.
Almirall J, Ponz E, López T, et al. [Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L]. Nefrologia. 2001;21(5):485-92.
Almirall, J., Ponz, E., López, T., Trallero, R., Valls, R., Rodríguez, A., Martínez, J. C., & García, M. (2001). [Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L]. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 21(5), 485-92.
Almirall J, et al. [Assessment of Long-term Bone Metabolism in Patients With Relative Hypoparathyroidism After Changing the Calcium Concentration of the Dialyzate to 3mEq/L]. Nefrologia. 2001 Sep-Oct;21(5):485-92. PubMed PMID: 11795018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L]. AU - Almirall,J, AU - Ponz,E, AU - López,T, AU - Trallero,R, AU - Valls,R, AU - Rodríguez,A, AU - Martínez,J C, AU - García,M, PY - 2002/1/25/pubmed PY - 2002/8/1/medline PY - 2002/1/25/entrez SP - 485 EP - 92 JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia VL - 21 IS - 5 N2 - The existence of a low-bone turnover, non-aluminium related, has been more prevalent in recent years. Factors involved include the increasing number of older and diabetic patients initiating dialysis. Also higher intake of calcium salts and the widespread use of vitamin D derivates may play a role. Demonstration of low PTH secretion allows the recognition of the group of patients with special risk of adynamic bone disease. Little can be done to improve bone remodelling apart from correct management of risk factors previously mentioned. A decrease in dialysate calcium concentration can act in this way, but the long term effect of this procedure on bone mineral density has scarcely been established. The aim of this study was to evaluate the long term effect of lowering the dialysate calcium concentration from 3.5 to 3 mEq/L on bone mass and PTH activity in patients with hypoparathyroidism. We studied 19 patients with PTH < 120 pg/ml and calcemia between 8.5 and 10.5 mg/dl, without aluminium intoxication. Blood levels of Ca, P, alkaline phosphatase, aluminium, iPTH and dialysis doses were measured every 4 months during the two years of follow-up. Phosphate binders were closely monitored. Also calcium dietary feeding was measured by a 5-day dietetic registry at the beginning and 6 and 12 months later. Bone mineral density was assessed by quantitative computed tomography of the distal radius initially and after 18 months. PTH values had significantly increased from the first measurement (from 46 +/- 33 to 97 +/- 68 four months later). At the end of follow up, 8 patients (42%) had reached the objective of maintaining a PTHi above 120 pg/ml, while 11 had not reached it (3 were previously parathyroidectomized and two were diabetic). Only one patient has developed an exaggerated PTH response that has been controlled with oral vitamin D. No bone mineral loss was observed during the follow up. In conclusion, the use of a 3 mEq/l dialysate calcium may improve hypoparathyroidism in a substantial number of patients, avoiding the untoward effect that lower calcium concentration has on bone mineralization. SN - 0211-6995 UR - https://www.unboundmedicine.com/medline/citation/11795018/[Assessment_of_long_term_bone_metabolism_in_patients_with_relative_hypoparathyroidism_after_changing_the_calcium_concentration_of_the_dialyzate_to_3mEq/L]_ L2 - http://www.revistanefrologia.com/es/linksolver/ft/ivp/0211-6995/21/485 DB - PRIME DP - Unbound Medicine ER -