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3 Is Metabolism of Divalent Ions in Our Peritoneal Dialysis Population Optimal?
Author(s) -
Benedik M,
Guček A
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1526-0968.2005.222_3_3.x
Subject(s) - medicine , peritoneal dialysis , sevelamer , phosphate binder , calcitriol , population , gastroenterology , divalent , renal osteodystrophy , bone remodeling , dialysis , bicarbonate , urology , endocrinology , surgery , kidney disease , hyperphosphatemia , vitamin d and neurology , chemistry , environmental health , organic chemistry
The problems of divalent ions, trace elements and bones are present in chronic dialysis patients despite optimal diet and therapy. Many patients have signs and symptoms of uremic osteopathy. Aim of the study To evaluate divalent ion metabolism and bone diseases in patients of our center for peritoneal dialysis. Methods In cross‐section study, we studied 41 patients (14 women, 27 men, mean age 56.6 ± 14.2 years) who were at least for 6 months (mean 52.9 ± 34.5 months) in our peritoneal dialysis (PD) program in the year 2003. Besides clinical, ultrasound, and X‐ray data, we evaluated their laboratory data in the last 3 years where available. Results Twenty‐seven patients used CAPD, 14 CCPD methods, 5/41 used PD 1 solution, 34/41 PD 4 and 2 both solutions. Thirty‐four patients used CaCO 3 , 18 aluminum hydroxide, and 9 sevelamer hydrochloride as phosphate binder as monotherapy or in combination. Sixteen patients used calcitriol and 9 sodium bicarbonate. Mean serum Ca in this population was 2.38 ± 0.09 (range 2.16–2.56) mmol/L, mean serum PO 4 1.46 ± 0.2 (range 1.13–2.23) mmol/L, mean serum alkaline phosphatase 1.44 ± 0.74 (range 0.61–5.3) µkat/L, mean serum Al 21.7 ± 12.1 (range 6.5–47.3) µg/L, mean i‐PTH was 454.07 ± 484 (range 1–1828) pg/mL and mean product of Ca and PO 4 was 3.48 ± 0.53 mmol 2 /L 2 (range 2.52–4.84). We found positive correlation between alkaline phosphatase and i‐PTH ( P = 0.000153) and between i‐PTH and serum Ca ( P = 0.025291). 25/41 (61%) patients had maximum i‐PTH higher than 200 pg/mL, 13/41 (32%) patients had maximum i‐PTH even higher than 600 pg/mL, 4 patients were waiting for parathyroidectomy, meanwhile 8/41 (19.5%) of patients had i‐PTH < 100 pg/mL, in 4 of them parathyroidectomy was done in the past. Conclusions Divalent metabolism is quite optimally achieved but secondary hyperparathyroidism still prevails in our PD patients. Management of divalent ions is very important before the beginning of peritoneal dialysis.