Renal Osteodystrophy: Pathophysiology and Treatment

Fournier, A; Sébert, J. L.; Morinière, P.; Grégoire, I.; Fremont, J. F. de; Tahiri, Youssef; Dkhissi, H

doi:10.1159/000179974

Cited by 11 publications

(6 citation statements)

References 17 publications

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“…This low prevalence of renal osteodystrophy differs strikingly from the reports in temperate areas [1,2]. The difference is immense notwithstanding the well recog nized fact that renal osteodystrophy varies according to centres, regions, countries [3,4], and also according to type and duration of the initial renal pathology [5,6], Although all details are not available about the initial renal diseases of the above patients, it is well accepted now that in the tropics glomerular diseases account for the vast majority of ESRF cases [7].…”

contrasting

confidence: 91%

“…Since the introduction of chronic dialysis, renal osteo dystrophy has been a major cause of concern in all parts of the world [1,2], However, in African patients treated at our centre, our impression was that bone disease was not a major problem. We therefore studied bone biochemis try, radiology and histology in 50 patients with end stage renal failure (ESRF).…”

mentioning

confidence: 87%

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Is Renal Osteodystrophy Rare in the Tropics?

Youmbissi

Ndi²,

Gonsu³

et al. 1990

Nephron

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contrasting

confidence: 91%

mentioning

confidence: 87%

Is Renal Osteodystrophy Rare in the Tropics?

Youmbissi

Ndi²,

Gonsu³

et al. 1990

Nephron

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“…This has prompted the search for safer phosphorus binders. Calcium carbonate and calcium citrate are two such candidates (13)(14)(15)(16)(17)(18)(19)(20)(21)(22); however, large doses are often required, and hypercalcemia is therefore a potential complication.…”

Section: Introductionmentioning

confidence: 99%

Reduction of dietary phosphorus absorption by phosphorus binders. A theoretical, in vitro, and in vivo study.

Sheikh¹,

Maguire²,

Emmett³

et al. 1989

J. Clin. Invest.

232

149

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Antacids used to decrease phosphorus absorption in patients with renal failure may be toxic. To find more efficient or less toxic binders, a three-part study was conducted. First, theoretical calculations showed that phosphorus binding occurs in the following order of avidity: Al3+ > H+ > Ca2+ > Mg2+. In the presence of acid (as in the stomach), aluminum can therefore bind phosphorus better than calcium or magnesium. Second, in vitro studies showed that the time required to reach equilibrium varied from 10 min to 3 wk among different compounds, depending upon solubility in acid and neutral solutions. Third, the relative order of effectiveness of binders in vivo was accurately predicted from theoretical and in vitro results; specifically, calcium acetate and aluminum carbonate gel were superior to calcium carbonate or calcium citrate in inhibiting dietary phosphorus absorption in normal subjects. We concluded that: (a) inhibition of phosphorus absorption by binders involves a complex interplay between chemical reactions and ion transport processes in the stomach and small intestine; (b) theoretical and in vitro studies can identify potentially better in vivo phosphorus binders; and (c) calcium acetate, not previously used for medical purposes, is approximately as efficient as aluminum carbonate gel and more efficient as a phosphorus binder than other currently used calcium salts.

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“…Grave met astatic calcifications might therefore be a concern during long-term therapy, and the need to monitor serum calcium levels during treatment is self-evident. The data reported concerning the serum PTH are contra dictory [11,13]. However, as recent studies have indi cated that aluminum is also involved in the regulation of PTH secretion [5], it could well be that the prevailing aluminum status of the patients investigated co-determined the serum level of PTH after withdrawal of the aluminum-containing drugs.…”

Section: Calcium Carbonatementioning

confidence: 99%

Treatment of Uremic Hyperphosphatemia -Is There Still a Need for Aluminum Salts?

Schaefer

Herrath²,

Erley³

1988

Am J Nephrol

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Aluminum-containing phosphate binders have been widely employed in the past in the management of uremic hyperphosphatemia. However, an increasing number of reports on aluminum toxicity has stimulated efforts to replace this therapy by safer methods. The aim of the present review is to critically evaluate other treatment strategies. It appears that aluminum-containing phosphate binders should no longer be considered the treatment of choice for controlling uremic hyperphosphatemia. Calcium carbonate, calcium citrate, magnesium carbonate and a mixture of ketoanalogues and amino acids present important therapeutical alternatives which could replace aluminum-containing phosphate binders in the majority of patients. However, it is mandatory, as these therapies also carry some risks, that side effects are detected early.

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Renal Osteodystrophy: Pathophysiology and Treatment

Cited by 11 publications

References 17 publications

Is Renal Osteodystrophy Rare in the Tropics?

Is Renal Osteodystrophy Rare in the Tropics?

Reduction of dietary phosphorus absorption by phosphorus binders. A theoretical, in vitro, and in vivo study.

Treatment of Uremic Hyperphosphatemia -Is There Still a Need for Aluminum Salts?

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