MEASUREMENT OF WHOLE BODY CALCIUM IN CHRONIC RENAL FAILURE: EFFECTS OF lα‐HYDROXYVITAMIN D<sub>3</sub> AND PARATHYROIDECTOMY

Naik, R. B.; Dabek, J. T.; Heynen, G; James, Helen; Kanis, J. A.; Robertson, P. W.; Robinson, Brian H.; Woods, C. G.

doi:10.1111/j.1365-2265.1977.tb03374.x

Cited by 11 publications

(8 citation statements)

References 10 publications

(6 reference statements)

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“…We observed an excellent remineralization of bone after total PTX in all sHPT patients. This important issue is also supported by several previous studies [14,[48][49][50]. Moreover, a recent report showed an increase in bone density and increasing levels of bone formation serum markers after total PTX [51].…”

Section: ) In Allsupporting

confidence: 75%

Long-Term Results of Total Parathyroidectomy without Autotransplantation in Patients with and without Renal Failure

Hampl¹,

Steinmüller²,

Fröhling³

et al. 1999

Mineral Electrolyte Metab

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The optimal surgical procedure for severe renal secondary hyperparathyroidism (sHPT) is still a point of controversy. Total parathyroidectomy (PTX) without auto-transplantation was abandoned for fear of an adynamic bone condition; however, in the case of autotransplantation recurrent sHPT is frequent and promotes atherosclerosis. We studied 11 hemodialysis patients (age 59±12 years) on dialysis for 18 (12–30) years in whom total PTX was performed due to severe sHPT (group I; intact PTH: 1,240±230 pg/ml), and 5 patients (age 55±10 years) without renal insufficiency who inadvertently received total PTX during thyroid surgery (group II). After total PTX (group I, 26±18 [9–59] months; group II, 252±188 [22^480] months) both groups showed no measurable intact PTH levels. Calcium homeostasis was maintained by oral substitution with calcium (group I, calcium dialysate of 2.0 mmol/l), vitamin D and calcitriol (serum parameters in groups I and II: calcium 2.4 and 2.2 mmol/l; phosphate 1.8 and 1.1 mmol/l; 25(OH)-vitamin D₃ 21 and 34 ng/ml; 1,25(OH)₂-vitamin D₃ 32 and 41 pg/ml, respectively). In group I, after total PTX there was a rapid and sustained improvement in bone pain with markedly enhanced physical activity and endurance. High turnover osteopathy markedly improved as indicated by declining levels of native osteocalcin (90±17 vs. 26±18 ng/ml), bone alkaline phosphatase (74±12 vs. 12±6 ng/ml), and carboxyterminal cross-linked telopeptide of type-I collagen (65±16 vs. 40±21 ng/ml) but increasing levels of carboxyterminal propeptide of type-I procollagen (120±36 vs. 148±41 ng/ml). Recalcification of bone was excellent as demonstrated by X-ray and confirmed by bone histology. Itching extravascular calcific deposits and calcifications of blood vessel and cardiac valves immediately stopped after total PTX. Moreover, 6 sHPT patients suffered from severe atherosclerotic lesions such as thoracic aortic aneurysm (n = 3) or abdominal aortic aneurysm (n = 3) which showed size progression before but not after total PTX when annually controlled by ultrasonography. In group II, even long after total PTX, there was no clinical, radiological, histological or biochemical evidence for low turnover osteopathy. In conclusion, our data indicate that substitution with vitamin D₃ metabolites and calcium can prevent deleterious bone effects of hypoparathyroidism in hemodialysis patients and in patients with normal kidney function and may compensate for the missing PTH action. Over this, a better survival rate is expected as a consequence of the beneficial effect of total PTX on the progression of atherosclerotic lesions. We suggest reconsideration of total PTX without autotransplantation in dialysis patients with severe sHPT who are not eligible for renal transplantation.

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Section: ) In Allsupporting

confidence: 75%

Long-Term Results of Total Parathyroidectomy without Autotransplantation in Patients with and without Renal Failure

Hampl¹,

Steinmüller²,

Fröhling³

et al. 1999

Mineral Electrolyte Metab

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“…The present study, however, contains 3 patients with hyperparathyroidism over many years who had significantly negative calcium balance over the same period. In this regard, others have shown increases in TBC following parathyroidectomy [31,34], and nega tive trends in BMM can be reversed with parathyroidec tomy [16].…”

Section: Commentsmentioning

confidence: 99%

“…In dialysis patients oral calcium [32], vitamin D ther apy [33,34], and proper dialysate calcium concentrations [14,15,35] are necessary to prevent negative calcium balance. Early in this study, 7 patients (No.…”

Section: Commentsmentioning

confidence: 99%

Calcium Balance in Uremia: Longitudinal Study of Long-Term Survivors

Schuster

Chesnut

Baylink

et al. 1985

Nephron

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Twelve male patients surviving uremia of 9–15 years duration were studied sequentially over a mean period of 9.2 years. Radiographs, bone biopsies, bone mineral mass (BMM) measured by photon absorptiometry, and total body calcium (TBC) determined by in vivo neutron activation analysis (NAA) were used. Pathologic fractures correlated with TBC corrected for height: 4 of 5 patients without fractures had TBC above 80% predicted, whereas 5 of 7 patients with fractures fell below this value. Unlike previous studies, negative calcium balance was seen in 3 patients with prolonged hyperparathyroidism. Though soft tissue calcification occurred in 6 patients, only 1 with massive shoulder calcification had an increase in TBC; this drawback of NAA has been previously overemphasized. Moreover, radial BMM also increased in 2 patients due to soft tissue calcification. When viewed at a single point in time, nearly all patients fell within the wide normal limits of BMM vs TBC. However, 6 patients with variable bone histology studied sequentially over a mean of 8.5 years showed significant preferential loss of radial bone mass compared to TBC. Aluminium retention did not influence calcium balance in these subjects.

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“…While it is now recognised that disturbance of vitamin D metabolism has a central role in the pathogenesis of renal osteodystrophy, the con centration of calcium in the dialysis fluid has also been thought to be of importance in haemodialysis patients [I], However, while using a dialysate calcium concentration of 1.5 mmol/1 or higher may prevent hypocalcaemia and im prove calcium balance [2][3][4][5] there is still controversy regard ing the effect of dialysate calcium concentrations on bone disease [6,7], By contrast, short-term treatment of renal osteodystrophy with synthetic active metabolites of vit amin D has produced promising improvement in renal bone disease [8] except when this is aluminium-induced [9].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effect of Dialysate Calcium and 1α-Hydroxycholecalciferol on Bone Calcium Content in Haemodialysis Patients as Measured by Neutron Activation Analysis of the Forearm

Smith¹,

Winney²,

Strong³

et al. 1981

Nephron

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The effect of different concentrations of dialysate calcium and treatment with 1α-OHD₃ on bone calcium content in haemodialysis patients was investigated over a 2½-year period. Part-body neutron activation analysis of the forearm with ²⁵²Cf was used to measure both an initial absolute calcium content and changes in the bone calcium. A highly significant inverse correlation (r = –0.84, p < 0.001) was found between the initial calcium content and the duration of previous dialysis utilising a dialysate calcium concentration of 1.75 mmol/l. No significant difference was found between the changes in bone calcium in patients who continued using a dialysate calcium of 1.75 mmol/l and those whose dialysate calcium was reduced to 1.375 mmol/l. There was a significant increase of 16.7% (p < 0.01) in bone calcium over the 2½-year period in the patients receiving 1α-OHD₃. The results of the study suggest that bone calcium loss is not necessarily influenced by dialysate calcium concentration but that 1α -OHD₃ has a beneficial long-term effect on bone calcium content.

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MEASUREMENT OF WHOLE BODY CALCIUM IN CHRONIC RENAL FAILURE: EFFECTS OF lα‐HYDROXYVITAMIN D₃ AND PARATHYROIDECTOMY

Cited by 11 publications

References 10 publications

Long-Term Results of Total Parathyroidectomy without Autotransplantation in Patients with and without Renal Failure

Long-Term Results of Total Parathyroidectomy without Autotransplantation in Patients with and without Renal Failure

Calcium Balance in Uremia: Longitudinal Study of Long-Term Survivors

Long-Term Effect of Dialysate Calcium and 1α-Hydroxycholecalciferol on Bone Calcium Content in Haemodialysis Patients as Measured by Neutron Activation Analysis of the Forearm

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MEASUREMENT OF WHOLE BODY CALCIUM IN CHRONIC RENAL FAILURE: EFFECTS OF lα‐HYDROXYVITAMIN D3 AND PARATHYROIDECTOMY

Cited by 11 publications

References 10 publications

Long-Term Results of Total Parathyroidectomy without Autotransplantation in Patients with and without Renal Failure

Long-Term Results of Total Parathyroidectomy without Autotransplantation in Patients with and without Renal Failure

Calcium Balance in Uremia: Longitudinal Study of Long-Term Survivors

Long-Term Effect of Dialysate Calcium and 1α-Hydroxycholecalciferol on Bone Calcium Content in Haemodialysis Patients as Measured by Neutron Activation Analysis of the Forearm

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Product

Resources

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MEASUREMENT OF WHOLE BODY CALCIUM IN CHRONIC RENAL FAILURE: EFFECTS OF lα‐HYDROXYVITAMIN D₃ AND PARATHYROIDECTOMY