Nephrology Dialysis Transplantation, Vol 12, Issue 10 2144-2150, Copyright © 1997 by Oxford University Press
M Couttenye, P D'Haese, J Deng, V Van Hoof, G Verpooten and M De Broe
Background: Adynamic bone disease (ABD) has been
described in the current dialysis population to have an unexpectedly high
prevalence. Moreover, it is clearly more prevalent in CAPD patients,
compared to haemodialysis patients. Recently we demonstrated that both a
low (⩽27 U/l) level of bone alkaline phosphatase (BAP) as
determined by an optimized agarose gel electrophoretic technique and a low
(⩽150 pg/ml) level of iPTH are good markers of ABD with
sensitivities of 78.1% and 80.6% and specificities of 86.4% and 76.2%
respectively. Methods: In this study (n=212), the
prevalence of ABD in the European CAPD population was evaluated by means of
these biochemical markers. Clinical data on the patients included were
recorded at the moment of blood sampling. In patients under CAPD treatment
for longer than 9 months, we calculated an index of calcium exposure
through PD fluid. Results: In this population with a
low exposure to aluminium, the prevalence of ABD as indicated by either a
low level of BAP or PTH was 43%. The following risk factors could be
identified: advanced age, shorter time on renal replacement therapy, male
gender, and high calcium content of PD fluid. The index of calcium exposure
was significantly higher in the patients with low BAP and low iPTH levels
compared to those with either BAP>27 U/l or iPTH>150 pg/ml.
The latter finding gives further support to the hypothesis that a high
calcium load administered to renal failure patients may lead to
'oversuppressed' parathyroids in ABD. In a subgroup of patients with a high
level of BAP associated with a low iPTH level a profile previously shown to
be associated in the presence of aluminium overload, significantly higher
serum aluminium levels were noted, suggesting that even in patients with
low exposure to aluminium, this element still can affect bone metabolism.
Conclusion: A high prevalence of ABD-as diagnosed by
biochemical markers-was observed in the European CAPD population. A number
of risk factors could be put forward. The aetiology and pathogenesis of
this type of renal osteodystrophy remain to be elucidated, but appear,
however, to be multifactorial. Keywords: adynamic bone
disease; bone alkaline phosphatase; CAPD; parathyroid hormone
BRIEF REPORTS
High prevalence of adynamic bone disease diagnosed by biochemical markers in a wide sample of the European CAPD population
University of Antwerp, Department of Nephrology-Hypertension, p/a University Hospital Antwerp, Wilrijkstraat 10, B-2650 Antwerpen, Belgium; Corresponding author
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