[Management of renal osteopathy in patients with chronic dialysis]

During the past decade considerable progress has been made in the field of calcium metabolism associated with chronic renal failure. The main factor influencing the pathophysiology of calcium homeostasis is its dependence on parathyroid hormone and active vitamin D metabolites. Among several new diagnostic tools, and to establish the diagnosis of renal osteodystrophy, only the measurement of i-PTH activity has any clinical relevance. The main goal in treating renal osteodystrophy is the lowering of PTH activity by correcting hyperphosphatemia and administration of calcitriol given either orally or intravenously. Furthermore, the need to lower the calcium concentration in the dialysate during calcitriol treatment is demonstrated. The clinical significance of adynamic osteodystrophy is still unclear.