Advertisement

Effect of CAPD on Renal Osteodystrophy in Unmodified Patients Moving from Hemodialysis to CAPD

  • J. A. Pederson
  • A. J. Felsenfeld
  • A. L. Voigts
  • F. Llach

Summary

The effect of one year of CAPD on bone histology was studied in seven hemodialysis patients changing to CAPD. The course of these patients was not modified by oral calcium supplements, vitamin D or parathyroid ablation. An existing pattern of dialysis osteomalacia in three patients changed in two to osteitis fibrosa. This change was associated with decreased stainable aluminum in the bone biopsies obtained during CAPD. The specific role played by CAPD in effecting this change is uncertain. Progression and development of osteitis fibrosa in these patients was not prevented by a 7.0 mg/dl calcium containing dialysis solution. The observed persistence of abnormally high parathyroid hormone levels and increasing alkaline phosphatase concentrations supports the concept that a negative calcium balance may be a critical factor in progression of osteitis fibrosa among CAPD patients.

Keywords

Renal Osteodystrophy Osteitis Fibrosa Negative Calcium Balance Oral Calcium Supplement Serum Phosphorus Concentration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ellis HA, Pierides AM, Feest TG, Ward MK, and Kerr DNS: Histopathology of renal osteodystrophy with particular reference to the effects of 1-hydroxyvitamin D3 in patients treated with long term haemodialysis. Clin Endocrinol 7 (Suppl): 315, 1977CrossRefGoogle Scholar
  2. 2.
    Coburn JW, Brickman AS, Sherrard DJ, Singer FR, Wang EGC, Baylink DJ, and Norman AW: Use of 1–25(OH)2 vitamin D3 to separate types of renal osteodystrophy. Proc Eur Dial Transplant Assoc 14: 442, 1977PubMedGoogle Scholar
  3. 3.
    Hodsman AB, Sherrard DJ, Wang EC, Brickman AD, Lee DBN, Alfrey AC, Singer FR, Norman AW, and Coburn JW: Vitamin D resistant osteomalacia in hemodialysis patients lacking secondary hyperparathyroidism. Ann Intern Med 94: 629, 1981PubMedCrossRefGoogle Scholar
  4. 4.
    Cournot-Witmer G, Zingraff J, Plachot JJ, Escaig F, Lefevre R, Boumati P, Bourdeau A, Garabédian M, Galle P, Bourdon R, Drüeke T, and Balson S: Aluminum localization in bone from hemodialysis patients: Relationship to matrix mineralization Kidney Int 20: 375, 1981Google Scholar
  5. 5.
    Ott SM, Maloney NA, Coburn JW, Alfrey AC, and Sherrard DJ: The prevalence of bone aluminum deposition in renal osteodystrophy and its relation to the response to calcitrol therapy. N Engl J Med 307: 709, 1982PubMedCrossRefGoogle Scholar
  6. 6.
    Ward MK, Feest TG, Ellis HA, Parkinson IS, Kerr DNS, Herrington J, and Goode GL: Osteomalacia dialysis osteodystrophy: Evidence for a water-borne aetiological agent, probably aluminium. Lancet 1: 841, 1978PubMedCrossRefGoogle Scholar
  7. 7.
    Parkinson IS, Ward MK, and Kerr DNS: Dialysis encephalopathy, bone disease and anaemia: The aluminium intoxication syndrome during regular haemodialysis. J Clin Pathol 34: 1285, 1981PubMedCrossRefGoogle Scholar
  8. 8.
    Hodsman AB, Sherrard DH, Alfrey AC, Ott S, Brickman AD, Miller NL, Maloney HA, and Coburn JW: Bone aluminum and histomorphometric features of renal osteodystrophy. J Clin Endocrinol Metab 54: 539, 1982PubMedCrossRefGoogle Scholar
  9. 9.
    Andreol SP, Bergstein JM, and Sherrard DJ: Aluminum intoxication from aluminum-containing phosphate binders in children with azotemia not undergoing dialysis. N Engl J Med 310: 1079, 1984CrossRefGoogle Scholar
  10. 10.
    Griswold WR, Reznik V, Mendoza A, Trauner D, and Alfrey AC: Accumulation of aluminum in a non-dialyzed uremic child receiving aluminum hydroxide. Pediatrics 71: 56, 1983PubMedGoogle Scholar
  11. 11.
    Kaye M: Oral aluminum toxicity in a non-dialyzed patient with renal failure. Clin Nephrol 20: 208, 1983PubMedGoogle Scholar
  12. 12.
    Felsenfeld A, Gutman RA, Llach F, and Harrelson JM: Osteomalacia in chronic renal failure: A syndrome previously reported only with maintenance dialysis. Am J Nephrol 2: 147, 1982PubMedCrossRefGoogle Scholar
  13. 13.
    Teitelbaum SL, Fallon MD, Gearing BK, Dougan CS, and Delmez JA: The effects of continuous ambulatory peritoneal dialysis (CAPD) on bone histomorphology. Kidney Int (Abstract) 21: 180, 1982Google Scholar
  14. 14.
    Gokal R, Ramos JM, Ellis H, Parkinson I, Sweetman V, Dewar J, Ward MK, and Kerr DNS: Histological renal osteodystrophy and 25 hydroxy cholecalciferol and aluminum levels in patients on continuous ambulatory peritoneal dialysis. Kidney Int 23: 15, 1983PubMedCrossRefGoogle Scholar
  15. 15.
    Digenis G, Khanna R, Pierratos A, Meema HE, Rabinovich S, Pettit J, and Oreopoulos DG: Renal osteodystrophy in patients maintained on CAPD for more than three years. Peritoneal Dial Bull 3: 81, 1983Google Scholar
  16. 16.
    Llach F, Felsenfeld A, and Haussier MR: The pathophysiology of altered calcium metabolism in rhabdomyolysis-induced acute renal failure: Interactions of parathyroid hormone, 25-hydroxycholecalciferol and 1–25 dihydroxycholecalciferol. N Engl J Med 305: 117, 1981PubMedCrossRefGoogle Scholar
  17. 17.
    LeGendre GR, and Alfrey AC: Measuring picogram amounts of aluminum in biological tissues by flame-less atomic absorption analysis of a chelate. Clin Chem 22: 53, 1976PubMedGoogle Scholar
  18. 18.
    Maloney NA, Ott SM, Alfrey AC, Miller NL, Coburn JW, and Sherrard DJ: Histological quantitation of aluminum in iliac bone from patients with renal failure. J Lab Clin Med 99: 206, 1982PubMedGoogle Scholar
  19. 19.
    Felsenfeld AJ, Harrelson JM, and Gutman RA: A quantitative histomorphometric comparison of 40 micron thick paragon sections with 5 micron thick goldner sections in the study of undecalcified bone. Calcif Tissue Int 34: 232, 1982PubMedCrossRefGoogle Scholar
  20. 20.
    Sokal RR, and Rahlf FJ: Biometry, 2nd Ed. New York: WH Freeman, 1981, p 448Google Scholar
  21. 21.
    deFremont JF, Morinière P, Kechzmareck P, Fievet P, Bataille P, and Fournier A: Hypercalcemia in continuous peritoneal dialysis patients (Abstract). Int Congr Nephrol 8: 399, 1981Google Scholar
  22. 22.
    Kurtz SB, Wong VH, Anderson CF, Vogel JP, McCarthy JT, Mitchell JC, Kumar R, and Johnson WJ: Continuous ambulatory peritoneal dialysis: Three years experience at the Mayo clinic. Mayo Clin Proc 58: 633, 1983PubMedGoogle Scholar
  23. 23.
    Alonso JLM, Martinez ME, Selgas R, Casares I, and Gomez P: Peritoneal clearance of parathyroid hormone (Abstract). Int Congr Nephrol 8: 420, 1981Google Scholar
  24. 24.
    Delmez JA, Slatopolsky E, Martin KJ, Gearing BN, and Harter HR: Minerals, vitamin D, and parathyroid hormone in continuous ambulatory peritoneal dialysis. Kidney Int 21: 862, 1982PubMedCrossRefGoogle Scholar
  25. 25.
    Delmez JA, Martin KJ, Harter HR, Gearing B, and Slatopolsky E: Effects of continuous ambulatory peritoneal dialysis on the removal of PTH in renal failure (Abstract). Am Soc Artif Intern Organs 9: 44, 1980Google Scholar
  26. 26.
    Thomson NM, Stevens BJ, Humphrey TJ, and Atkins RC: Comparison of trace elements in peritoneal dialysis, hemodialysis, and uremia. Kidney Int 23: 9, 1983PubMedCrossRefGoogle Scholar
  27. 27.
    Ihle BU, Buchanan MCR, Stevens B, Becker GJ, and Kincaid-Smith P: The efficacy of various treatment modalities on aluminum associated bone disease. Proc Eur Dial Transplant Assoc 19: 195, 1982Google Scholar
  28. 28.
    Morrisey J, Rothstein M, Mayor G, and Slatopolsky E: Suppression of parathyroid hormone secretion by aluminum. Kidney Int 23: 699, 1983CrossRefGoogle Scholar
  29. 29.
    Hercz G, Milliner DS, Shinaberger JH, Nissenson AR, Cutler RE, Goodman WG, Gentile DE, Kraus AP, and Coburn JW: Aluminum metabolism and record during CAPD (Abstract). Am Soc Nephrol 16: 120A, 1983Google Scholar
  30. 30.
    Sorkin MI, Nolph KD, Anderson HO, Morris JS, Kennedy J, Prowant B, and Moore H: Aluminum mass transfer during continuous ambulatory peritoneal dialysis. Peritoneal Dial Bull 1: 91, 1981Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • J. A. Pederson
    • 1
  • A. J. Felsenfeld
    • 1
  • A. L. Voigts
    • 1
  • F. Llach
    • 1
  1. 1.Department of MedicineUniversity of Oklahoma Health Sciences Center and VA Medical CenterOklahoma CityUSA

Personalised recommendations