Effects of in-center daily hemodialysis upon mineral metabolism and bone disease in end-stage renal disease patients

Sao Paulo Medical Journal - Tập 119 Số 3 - Trang 105-109 - 2001
Jocemir Ronaldo Lugon1, M André1, Maria Eugênia Leite Duarte1, Simone Martins Rembold1, Elisa de Albuquerque Sampaio da Cruz1
1Universidade federal Fluminense, Brazil

Tóm tắt

CONTEXT: Alternative hemodialysis schedules have been proposed to improve the quality of the dialysis. Nonetheless, their influence upon mineral and bone disorders is unknown. OBJECTIVE: To report the impact of a daily hemodialysis schedule upon the lesions of renal osteodystrophy. TYPE OF STUDY: Prospective non-controlled study. SETTING: Public University Hospital. PARTICIPANTS: Five patients treated by daily hemodialysis for at least 24 months. INTERVENTION: Daily dialysis sessions were accomplished with non-proportional dialysis machines without an ultrafiltration control device, with blood flow of 300 ml/min, bicarbonate dialysate ([Ca]=3.5 mEq/L) at 500 ml/min, and low-flux membrane dialyzers. Sessions were started at 6:00 p.m. (except Sundays) and lasted 2 hours. MAIN MEASUREMENTS: Serum levels of Ca and P from the last 6 months on conventional hemodialysis for the same patients were used for comparison with each semester of daily hemodialysis. Bone biopsies and PTH levels were obtained at the end of the conventional hemodialysis period and then again after 2 years of daily hemodialysis. RESULTS: Mean serum calcium was significantly higher during the second and third semesters of daily dialysis [10.0 mg% (SD 0.6), and 10.0 mg% (SD 0.8), respectively] compared to standard dialysis [9.4 mg% (SD 0.8)], p < 0.05. Mean values for phosphorus were significantly lower during every semester of daily hemodialysis [6.3 mg% (SD 1.8), 5.8 mg% (SD 1.7), 6.0 mg% (SD 1.7), and 6.0 mg% (SD 1.8)] compared to standard dialysis [7.2 mg% (SD 2.7)], P < 0.05. Variations in mean Ca x P product followed the same pattern as for phosphorus [59.5 (SD 16.0), 57.1 (SD 16.3), 59.8 (SD 17.7), and 58.31 (SD 20.9) vs. 68.6 (SD 27.3), P < 0.05]. After 2 years on daily hemodialysis, 2 patients who had aplastic lesion were found to have mild bone disorder. In addition, one patient with mixed bone lesion and moderate bone aluminum accumulation had osteitis fibrosa with no aluminum. Intact PTH values at the beginning of study and after 2 years on daily hemodialysis did not differ [134 pg/ml (SD 66) vs. 109 pg/ml (SD 26), P = 0.60, respectively]. CONCLUSIONS: Patients treated using daily hemodialysis had better control of serum phosphorus and perhaps a lower risk of metastatic calcifications. Daily hemodialysis also seemed to be beneficial to low turnover bone disease and bone aluminum deposition.

Từ khóa


Tài liệu tham khảo

Malluche H, 1990, Renal bone disease 1990: an unmet challenge for the nephrologist, Kidney Int, 38, 193, 10.1038/ki.1990.187

Sherrard DJ, 1993, The spectrum of bone disease in end-stage renal failure: an evolving disorder, Kidney Int, 43, 436, 10.1038/ki.1993.64

Hruska KA, 1995, Renal osteodystrophy, N Engl J Med, 333, 166, 10.1056/NEJM199507203330307

Miller JH, 1984, Technical aspects of high-flux hemodiafiltration for adequate short (under 2 hours) treatment, Trans Am Soc Artif Intern Organs, 30, 377

Fabris A, 1988, Total solute excretion versus clearance on the evaluation of standard and short hemodialysis, Trans Am Soc Artif Intern Organs, 34, 627

Ronco C, 1988, Comparison of four different short dialysis techniques, Int J Artif Organs, 11, 169, 10.1177/039139888801100308

Shimizu AG, 1983, Reducing patient morbidity from high-efficiency hemodialysis: a double-blind crossover trial, Trans Am Soc Artif Intern Organs, 29, 666

Marangoni R, 1992, Short time treatment with high-efficiency paired filtration dialysis for chronic renal failure, Artif Organs, 16, 547, 10.1111/j.1525-1594.1992.tb00550.x

Charra B, 1992, Survival as an index of adequacy of dialysis, Kidney Int, 41, 1286, 10.1038/ki.1992.191

Charra B, 1996, Importance of treatment time and blood pressure control in achieving long-term survival on dialysis, Am J Nephrol, 16, 35, 10.1159/000168968

Buoncristiani U, 1988, Daily dialysis: Long-term clinical metabolic results, Kidney Int, 33, S137

Kenley RS, 1995, Will daily home hemodialysis be an important future therapy for end-stage renal disease?, Seminars in Dialysis, 8, 261, 10.1111/j.1525-139X.1995.tb00399.x

Buoncristiani U, 1996, Reversal of left-ventricular hypertrophy in uremic patients by treatment with daily hemodialysis, Contrib Nephrol, 119, 152, 10.1159/000425466

Lugon JR, 1997, Improvements in dialysis adequacy and quality of life by in-center daily hemodialysis, J Am Soc Nephrol, 8, 165A

Villanueva AR, 1977, Modifications of the Goldner and Gomori one-step trichrome stains for plastic-embedded thin sections of bone, Am J Med Technol, 43, 536

Maloney NA, 1982, Histological quantification of aluminum in iliac bone from patients with renal failure, J Lab Clin Med, 99, 206

Andress DL, 1987, Osteomalacia and aplastic bone disease in aluminum-related osteodystrophy, J Clin Endocrinol Metabol, 65, 11, 10.1210/jcem-65-1-11

Goodman WG, 1996, Renal osteodystrophy in adults and children, 3, 341

Parfitt AM, 1987, Bone histomorphometry: Standardization and nomenclature, symbols and units, J Bone Miner Res, 2, 595, 10.1002/jbmr.5650020617

Lazarus JM, 1996, Hemodialysis, 2, 5, 2424

Pierratos A, 1998, Nocturnal hemodialysis: three-year experience, J Am Soc Nephrol, 9, 859, 10.1681/ASN.V95859

Massry SG, 1973, Skeletal resistance to parathyroid hormone in renal failure, Ann Intern Med, 78, 357, 10.7326/0003-4819-78-3-357

Hsu CH, 1994, The biological action of calcitriol in renal failure, Kidney Int, 46, 605, 10.1038/ki.1994.312

Splendiani G, 1983, Extraction of middle molecules with daily short dialysis, Progr Artif Organs, 452

Salusky IB, 1991, Renal bone disease in pediatric patients receiving treatment with maintenance peritoneal dialysis, Child Nephrol Urol, 11, 165

Hernandez D, 1994, Adynamic bone disease with negative aluminum staining in pre-dialysis patients: prevalence and evolution after maintenance dialysis, Nephrol dial Transplant, 9, 517, 10.1093/ndt/9.5.517

Thông tin
Thông tin xuất bản

Sao Paulo Medical Journal

Tập 119 Số 3

105-109

Thông tin tác giả