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The identification of bone mineral density in CAPD in comparison with HD patients
P Pasadakis1, E Thodis, J Manavis
1Democritus University of Thrace, Division of Nephrology, General District Hospital, Alexadroupolis, Greece.
Insights
Chronic renal failure (CRF) impacts bone health. This study found continuous ambulatory peritoneal dialysis (CAPD) patients had better bone mineral density (BMD) than hemodialysis (HD) patients, suggesting dialysis type affects bone status.
Area of Science:
- Nephrology
- Bone Metabolism
- Mineral Disorders
Background:
- Renal osteodystrophy is a common complication of chronic renal failure (CRF).
- Dialysis management for end-stage renal failure can further complicate bone health.
- Calcium-phosphate metabolism derangements are prevalent in CRF patients.
Purpose of the Study:
- To evaluate and compare bone mineral density (BMD) in predialytic CRF patients, continuous ambulatory peritoneal dialysis (CAPD) patients, and hemodialysis (HD) patients.
- To assess the impact of different dialysis modalities on bone mineral metabolism.
- To correlate BMD with biochemical and radiological bone studies.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was used to measure BMD.
- Three patient groups were studied: 10 CAPD, 10 HD, and 10 predialytic advanced CRF patients.
- Patients were matched for age, sex, dialysis duration (>3 years), and phosphate binder use. Biochemical (serum iPTH, SAP, Ca, P) and radiological bone assessments were performed.
Main Results:
- Predialytic patients generally had normal BMD. CAPD patients exhibited higher BMD (0.985 g/cm²) compared to HD patients (0.949 g/cm²).
- Some HD patients showed BMD increases over time.
- Radiological signs of high turnover bone disease and osteopenia correlated with BMD.
Conclusions:
- Dialysis significantly affects bone status in chronic renal failure patients.
- Continuous ambulatory peritoneal dialysis (CAPD) appears to offer better bone mineral metabolism compared to hemodialysis (HD).
- BMD measurements are a key indicator for assessing bone health in dialysis patients.
Abstract:
Renal osteodystrophy is a virtually universal complication of chronic renal failure (CRF). Varying degrees of calcium-phosphate metabolism derangement and different types of skeletal damage are observed in CRF for many reasons while the use of dialysis for the management of end-stage renal failure further affects these complications. This study was designed to evaluate the bone mineral density (BMD) that is measured by dual-energy x-ray in three groups of patients: A, 10 patients on continuous ambulatory peritoneal dialysis (CAPD); B, 10 patients on hemodialysis (HD); and C, 10 predialytic patients with advanced CRF. All patients were matched for age, sex, duration of dialysis (> 3 years), and the use of phosphate binders. Biochemical (serum iPTH levels, SAP, Ca, P) and radiological bone studies were compared in the three groups. The majority of predialytic patients had BMD values within the normal range, while the BMD values in PD patients were higher (0.985 g/cm2) in comparison with HD patients (0.949 g/cm2). Some patients, especially in the HD population, showed an increase in BMD with time on dialysis. From all other comparisons, radiological signs of high turnover bone disease and osteopenia were the only variables that were correlated with BMD. All these findings suggest that dialysis affects the bone status and that CAPD patients have better bone mineral metabolism as shown mainly with the use of BMD measurements.