Pamidronate (APD), a third-generation bisphosphonate, has proven to be useful in haemodialysis (HD) patients with ectopic calcifications and hypercalcaemia. Little is known about bisphosphonates clearance in patients undergoing HD. The authors' main objective was to study HD removal and clearance of APD. In total, 23 HD-requiring anuric end-stage renal disease (ESRD) adult individuals (12 men) aged 61.7 +/- 13 (mean +/- SD) years were admitted into the study. APD clearance and elimination were evaluated by (99m)Technetium APD (half-life 6 h). In total, 1 mg of labelled APD was injected via the arteriovenous graft prior to the start of HD. Blood samples were then drawn from the arterial (predialyser) and venous (postdialyser) lines of the extracorporeal circuit 2 h after the HD onset. In a subgroup of patients (n: 15) the dialysate was collected and quantified during the three initial HD hours. Venous APD concentrations (postdialyser) were 72 + 7% of arterial (predialyser) concentrations. Mean APD clearance was 69.3 + 16.6 mL/min, and mean APD extraction during dialysis session was 31.6 + 10.1%. In the present study involving HD-requiring anuric ESRD patients APD was successfully eliminated by HD. At the dose administered here none of the participants reported adverse events. APD is a potentially useful drug to be administered to HD-requiring ESRD patients, the understanding of its removal during HD as well as its dialytic clearance allows for a safer management of a drug that is usually eliminated by renal excretion.

Both folic acid doses induced a significant and similar decrease in plasma Hcy in subjects with moderate-severe chronic renal failure. The possible dose-related effect of this approach in reducing the risk of accelerated sclerotic vascular disease and cardiovascular events in this especially vulnerable population should be a matter of further investigation.

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BACKGROUND: Low vitamin D serum levels represent an additional risk factor for end-stage renal disease (ESRD)-associated bone disorders. The aim of this study was to evaluate the prevalence of vitamin D defi ciency in both the summer and winter seasons, as well as to defi ne the associated risk factors, and to establish the link between secondary hyperparathyroidism and circulating 25-hydroxy vitamin D (25 [OH]-D) serum levels.METHODS: Seventy-eight hemodialysis (HD)-requiring ESRD outpatients living in Buenos Aires, Argentina, age 57.2 Ϯ 2.07 years (21-86 years) were evaluated at the end of summer (SUM) and the end of winter (WIN). Then 25 (OH)-D, serum calcium (Ca), intact parathormone, ionized Ca (Ca ϩϩ ), phosphate, alkaline phosphatase, creatinine, C-reactive protein, and serum albumin were evaluated. The participants were evaluated according to the 25 (OH)-D levels following KDOQI guidelines. The participants were assigned to 2 groups according to their Karnofsky scores for functional capacity (FC): FC 1-2 (normal physical capacity full-time to only part-time) and FC 3-4 (limited capacity only for self care to needs permanent assistance). CONCLUSIONS: Fifty percent of the HD-requiring ESRD patients showed 25 (OH)-D insuffi ciency/defi ciency. This fi nding was more frequent in winter. Women and older patients were at higher risk. Those individuals displaying optimal 25 (OH)-D levels showed better health indicators for HD-requiring ESRD patients. FC assessed through the Karnofsky score was a useful clinical parameter able to identify patients at risk of 25 (OH)-D defi ciency. In our population, renal disease-associated secondary hyperparathyroidism did not correlate with vitamin D defi ciency.

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