Journal Article

Spectrum of renal bone disease in end‐stage renal failure patients not yet on dialysis

Goce B. Spasovski, An R. J. Bervoets, Geert J. S. Behets, Ninoslav Ivanovski, Aleksander Sikole, Geert Dams, Marie‐M. Couttenye, Marc E. De Broe and Patrick C. D'Haese

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 6, pages 1159-1166
Published in print June 2003 | ISSN: 0931-0509
Published online June 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg116
Spectrum of renal bone disease in end‐stage renal failure patients not yet on dialysis

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Background. During the last few years the spectrum of renal osteodystrophy (ROD) in dialysis patients has been studied thoroughly and the prevalence of the various types of ROD has changed considerably. Whereas until a decade ago most patients presented with secondary hyperparathyroidism (HPTH), adynamic bone (ABD) has become the most common lesion within the dialysis population over the last few years. Much less is known about the spectrum of ROD in end‐stage renal failure (ESRF) patients not yet on dialysis.

Methods. Transiliac bone biopsies were taken in an unselected group of 84 ESRF patients (44 male, age 54±12 years) before enrolment in a dialysis programme. All patients were recruited within a time period of 10 months from various centres (n=18) in Macedonia. Calcium carbonate was the only prescribed medication in patients followed up by the outpatient clinic.

Results. HPTH was found in only 9% of the patients, whilst ABD appeared to be the most frequent renal bone disease as it was observed in 23% of the cases next to normal bone (38%). A relatively high number of patients (n=10; 12%) fulfilled the criteria of osteomalacia (OM). Mixed osteodystrophy (MX) was diagnosed in 18% of the subjects. There was no significant difference between groups in age, creatinine, or serum and bone strontium and aluminium levels. Patient characteristics associated with ABD included male gender and diabetes, whilst OM was associated with older age (>58 years).

Conclusions. In an unselected population of ESRF patients already, 62% of them have an abnormal bone histology. ABD is the most prevalent type of ROD in this population. In the absence of aluminium or strontium accumulation the relatively high prevalence of a low bone turnover as expressed by either normal bone or ABD and OM is striking.

Keywords: adynamic bone disease; ESRF; hyperparathyroidism; osteomalacia; predialysis; renal osteodystrophy

Journal Article.  6149 words.  Illustrated.

Subjects: Nephrology

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