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Risk factors for renal osteodystrophy: A multivariant analysis
Author(s) -
Pei York,
Hercz Gavril,
Greenwood Celia,
Segre Gino,
Manuel Arif,
Saiphoo Carl,
Fenton Stanley,
Sherrard Donald
Publication year - 1995
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.5650100121
Subject(s) - medicine , renal osteodystrophy , bone disease , hemodialysis , parathyroidectomy , surgery , peritoneal dialysis , osteitis , osteodystrophy , dialysis , osteitis fibrosa cystica , kidney disease , secondary hyperparathyroidism , gastroenterology , hyperparathyroidism , osteoporosis , parathyroid hormone , calcium , osteomyelitis
To assess the risk factors associated with renal osteodystrophy, we examined the database of 256 patients who were prospectively studied in three Toronto dialysis centers between October of 1987 and 1989. The potential risk factors examined included age, sex, type and duration of dialysis, type and dose of phosphate binders, vitamin D treatment, and history of diabetes mellitus, renal allograft failure, parathyroidectomy, and bilateral nephrectomy. All patients had undergone a bone biopsy and were categorized into one of four disease groupings: (1) osteitis fibrosa and mixed bone disease, (2) aluminum bone disease, (3) mild bone disorder, and (4) aplastic bone disorder. The mean (±SD) age of the patients at bone biopsy was 57 ± 15 years, and 62% were men. Forty‐five percent of patients were treated by hemodialysis and 55% by peritoneal dialysis. The mean duration of dialysis was 4 ± 4 years. Twenty‐five percent were also diabetic. The most common disorder was the aplastic (or “adynamic”) bone disorder, found in 34% of patients. Aluminum bone disease was found in 27%, osteitis fibrosa or mixed bone disease in 27%, and mild bone disorder in 12% of patients. Cumulative intake of aluminum gels was associated with aluminum bone disease, whereas peritoneal dialysis with supraphysiologic calcium concentrations, ingestion of calcium carbonate, and diabetes mellitus were associated with both mild bone disorder and aplastic bone disorder. These three latter risk factors may be important in predisposing patients to a low bone turnover state through modulation of parathyroid hormone secretion. Thus, recent increases in the frequencies of these risk factors in dialysis patients are associated with a high prevalence of aplastic bone disorder. The clinical significance of this bone disorder remains to be defined.