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Variable response to long-term 1alpha-hydroxycholecalciferol in haemodialysis osteodystrophy
Lancet (London, England)
|May 22, 1976
Summary
1alpha-hydroxycholecalciferol (1alpha-H.C.C.) effectively treated renal osteodystrophy in five hemodialysis patients. However, it was ineffective in five others with osteomalacia, suggesting other factors contributed to their bone disease.
Area of Science:
- Nephrology
- Endocrinology
- Bone Metabolism
Background:
- Renal osteodystrophy is a common complication in patients with chronic kidney disease undergoing regular hemodialysis.
- Vitamin D deficiency and impaired calcium-phosphate metabolism contribute to bone disease in uremia.
Purpose of the Study:
- To evaluate the efficacy and safety of 1alpha-hydroxycholecalciferol (1alpha-H.C.C.) in treating renal osteodystrophy in hemodialysis patients.
- To identify patient subgroups that may or may not respond to 1alpha-H.C.C. treatment.
Main Methods:
- Ten uraemic patients on regular haemodialysis received 1alpha-H.C.C. for 5 to 14 months.
- Clinical, radiological, biochemical, and histological assessments were performed before and during treatment.
Main Results:
- Five patients with osteitis fibrosa showed significant improvement, including pain resolution, normalized alkaline phosphatase, and improved bone histology.
- Five patients with osteomalacia and minimal osteitis fibrosa did not improve and experienced hypercalcemia.
- Bone histology in non-responders showed no improvement after treatment.
Conclusions:
- 1alpha-H.C.C. is safe and effective for hemodialysis patients with osteitis fibrosa.
- 1alpha-H.C.C. alone may be ineffective in patients with significant osteomalacia, potentially due to factors beyond vitamin D deficiency, such as phosphate depletion.