Renal Osteodystrophy

Endocrinology and Dialysis Jean L. Holley, Series Editor: Osteoporosis and Chronic Kidney Disease

“…Previously referred to as renal osteodystrophy (ROD), this complex pathophysiologic syndrome has recently been redefined as chronic kidney disease‐mineral and bone disease (CKD‐MBD) (4). The disorders of bone and mineral metabolism associated with CKD‐MBD also lead to a significant increased fracture risk (5). The coexistence of OP and CKD‐MBD in patients with CKD seems to predispose these patients to fracture, morbidity, and mortality rates much higher than those observed in the normal population (6–8).…”

Chronotherapy of high-dose 1,25-dihydroxyvitamin D in hemodialysis patients with secondary hyperparathyroidism: A single-dose study

“…Vitamin D supplement therapy is widely used for the treatment of osteoporosis and renal osteodystrophy in patients with chronic renal failure 1 . In vitro study shows that a higher concentration of 1,25‐dihydroxycholecalciferol (1,25‐dihydroxyvitamin D 3 ) directly suppresses cellular growth of the parathyroid gland 2 .…”

Phosphorus‐Enriched Hemodialysates: Formulations and Clinical Use

“…For a normal 70 kg individual, the intake of phosphorus is of the order of 20 mg/kg/day (9.8 g/week), while 7 mg/kg/day (3.43 g/week) and 13 mg/kg/day (6.37 g/week) are excreted in the feces and the urine, respectively [1,2]. In the absence of urinary function, however, retention of phosphorus with resultant hyperphosphatemia takes place [1–6]. The small, renal failure‐related increment in the gastrointestinal fractional excretion of phosphorus (from a normal value of 25 to 31%) is not high enough to outweigh the reduction in urinary excretion [6].…”

“…A conventional dialysis treatment ordinarily removes approximately 900 mg of phosphorus, i.e., 2.7 g/week in the case of the thrice‐weekly dialysis treatment regimen [6]. This relatively poor removal is related to the low dialyzer clearance of phosphorus, little or no removal from the erythrocytes, and a volume of distribution for phosphorus that is much larger than the extracellular space [5]. Furthermore, the distribution volume for phosphorus in a hemodialysis patient is multi‐compartmental in nature, rendering dialytic removal of phosphorus more difficult than if there were only one single compartment [7,8].…”

“…When one considers the substantial weekly positive balance of phosphorus, it comes as no surprise that in maintenance hemodialysis patients (with thrice‐weekly dialysis regimens) with absent or minimal renal function, hyperphosphatemia is the rule rather than the exception. Consequently, in such patients, additional therapy in the form of dietary phosphorus restriction, oral administration of phosphorus binders, or more intensive dialytic therapy is required [1–6].…”