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Disorders of phosphoRUS-calcIUM balance in patients on chronic hemodialysis
- Time-based duration relationship -
Ivan Kostić, Jelena Kostić, Branka Mitić, Svetislav Kostić, Vidojko Đorđević and Petar Babović
Clinic of Nephrology and Hemodialysis, Clinical Center Niš, Serbia
Chronic renal failure (CRF) is a progressive, irreversible deterioration of kidney function that leads to complete loss of kidney function and the need for dialysis treatment. Bone disease is a chronic complication in the CRF and poses a significant problem in hemodialysis patients.
The aim of our study was to assess the influence of peritoneal dialysis treatment on biochemical parameters of mineral and bone metabolism in hemodialysis patients, and identify the most important parameters for the monitoring of this disorder.
The research involved 172 patients, mean age 58.69±12:54, divided into groups in respect to the length of dialysis treatment (group I - 5 years, group II - 5-10 years and group III - over 10 years).
Serum phosphorus in all the patients was increased, but the values increased with duration of dialysis (I: 1.77±0.58, II: 1.97±0.66, III: 1.92±0.82), with no statistical differences (p>0.05). Calcemia values were significantly increased (I vs. II. and I vs. III, p<0.0001), as well as the values of Ca x P (I vs. II., p<0.001, II vs. III., p<0.01), primarily on the account of the increased calcium value. The values of alkaline phosphatase (I: 105.12±65.60; II: 125.27±96.79, III: 172.43±163.99) were significantly higher in group III compared to other groups (p <0.05). Also, the values of PTH (I: 234.21±18.74; II: 273.09±247.98; III: 489.46±468.49) were significantly higher in group III compared to other groups (p<0.001). In the group of patients with duration of dialysis up to 5 years, the values of phosphorus were increased, the values of calcemia were decreased, with mild elevation of AF and PTH values, which best corresponds to the bone disease with rapid turnover. In the P group, there is a significant increase in calcemia in respect to phosphorus, alkaline phosphatase, and PTH.
The most reliable marker for clinical monitoring of bone disease in dialysis patients is PTH, which correlates well with the values of alkaline phosphatase and calcium. The values of calcium and phosphorus are highly variable and not the most reliable markers for bone disease monitoring. Acta Medica Medianae 2011;50(1):32-37.
Key words: hemodialysis, duration, mineral and bone metabolism, PTH, calcium, phosphorus