Management of Renal Osteodystrophy in Peritoneal Dialysis Patients

Abstract

The term “renal osteodystrophy” encompasses all forms of metabolic bone disease found in dialysis patients. The primary approach to the treatment of renal osteodystrophy in peritoneal dialysis (PD) patients is similar to that in hemodialysis patients. However, the increased prevalence of adynamic bone histology, together with the difficulty in judging calcium balance, the inability to practicably give intravenous vitamin D, and the clearance of vitamin D and parathyroid hormone via dialysate require a different therapeutic approach in PD compared to hemodialysis patients. Clearly, more comparative studies of new agents are needed to find the optimal approach to achieving the K/DOQI guidelines in PD patients. The unique aspects of the approach to renal osteodystrophy in PD patients are the focus of this review.

Prospective study on dialysis patients after total parathyroidectomy without autoimplant

“…In the published work, there is no agreed definition of recurrence of hyperparathyroidism but it is now known that iPTH values below twice of normal are associated with low-turnover bone disease while those above 7-8 times of normal are associated with high-turnover bone disease. 25,26 So this patient developed adynamic bone disease 17 months after the total parathyroidectomy without autoimplant, followed by a recurrence of the hyperparathyroidism, at least biochemically, 4 years after the operation. MIBI 6 years postparathyroidectomy showed an abnormal area of uptake in the neck.…”

Refractory hyperparathyroidism with a T3 bony lesion—differential diagnoses

“…Brown tumour (osteitis fibrosa cystica) occurs in <5% of patients with pHPT in developed countries [ 7 ]. It also occurs in secondary and tertiary hyperparathyroidism particularly among dialysis patients, particularly with PTH > 50 pmol/l [ 8 ]. It is a benign, non-neoplastic tumour characterized by subperiosteal bone resorption and osteopenia [ 9 ].…”

Should Dialysate Calcium Concentration Be Standardised or Individualised?

“…Toussaint et al (2006) reviewed dialysate calcium concentration in HD and concluded that while medications are evolving, and new regimes for HD are emerging, flexibility needs to be maintained and dialysate Ca individualised. Moe (2004) concluded that individualisation of dialysate Ca is necessary for the management of renal osteodystrophy in PD patients. It seems likely that at least two dialysate Ca concentrations will be required to optimise bone management in any patient group.…”