Renal osteodystrophy in Ramathibodi Hospital: histomorphometry and clinical correlation

Area of Science:

• Nephrology
• Bone Metabolism
• Mineral and Bone Disorders

Background:

• Renal osteodystrophy is a common complication in chronic kidney disease patients undergoing dialysis.
• The specific spectrum and clinical relevance of renal osteodystrophy in the Thai dialysis population were previously uncharacterized.

Purpose of the Study:

• To determine the prevalence and clinico-pathological correlation of renal osteodystrophy in Thai chronic dialysis patients.
• To investigate the influence of dialysis duration and other factors on bone disease types and bone mineral density.

Main Methods:

• A cross-sectional study involving 56 chronic dialysis patients (CAPD and hemodialysis).
• Assessment included serum biochemistry (calcium, phosphate, iPTH, bone-specific alkaline phosphatase), bone histomorphometry, and dual-energy X-ray absorptiometry (DEXA) for bone mineral density (BMD).
• Renal osteodystrophy classification followed Fournier's criteria.

Main Results:

• Adynamic bone disease (41.1%) was the most common type, followed by hyperparathyroid (28.6%) and mixed types (19.6%).
• Dialysis duration significantly influenced the type of bone disease and was associated with higher iPTH and bone-specific alkaline phosphatase in high turnover bone diseases.
• Intact PTH > 200 pg/ml demonstrated high sensitivity (74%) and specificity (96%) for predicting high turnover bone disease.
• Chronic dialysis patients exhibited greater bone loss compared to the general Thai population, exacerbated by longer dialysis duration.

Conclusions:

• Significant bone diseases, particularly adynamic bone disease, are highly prevalent in Thai chronic dialysis patients.
• Dialysis duration is a key determinant of bone disease spectrum and progression, leading to increased bone loss.
• Intact PTH serves as a valuable predictive marker for high turnover bone disease in this population.