Rickers H, Christensen M, Rødbro P
Clin Nephrol. 1983 Dec;20(6):302-7.
Bone mineral content (BMC) was measured annually over a three year period in 31 consecutive patients on maintenance hemodialysis (HD). No patient had received treatment with vitamin D derivatives, anticonvulsants or corticosteroids, nephrectomy or a renal transplant. Initial median BMC value in per cent of sex and age matched normal mean was significantly decreased to 91.0% (P less than 0.01), indicating bone mineral loss in chronic renal failure prior to HD. During HD a highly significant fall in mean BMC (in per cent of initial value) continued to 95.1%, 92,7% and 90.8% after 1, 2 and 3 years, respectively, with no influence of age, sex or initial BMC value. The interindividual variation in BMC changes, however, was considerable: the BMC loss over 3 years exceeded 10% in 13 (42%) patients ("rapid losers") while 12 (39%) patients had a BMC loss below 5%, or no loss at all. The "rapid loser" group had significantly higher serum levels of parathyroid hormone and alkaline phosphatases and, moreover, developed a lower serum phosphate and calciumXphosphorus product than the other group of patients ("slow losers"). The mean BMC loss over 3 years of HD was pronounced and significant (P less than 0.02) in patients with chronic pyelonephritis (9.8%) and polycystic kidney disease (14.2%), but much smaller, and not significant, in patients with chronic glomerulonephritis (4.8%). It is concluded that a selection of patients with a high degree of bone mineral loss during HD is not possible by means of sex, age, initial BMC, biochemical parameters, or diagnosis (2 patients with chronic glomerulonephritis appeared to be "rapid losers"). For that purpose a high-precision BMC method is mandatory.
对31例维持性血液透析（HD）患者连续三年每年测量骨矿物质含量（BMC）。所有患者均未接受过维生素D衍生物、抗惊厥药或皮质类固醇、肾切除术或肾移植治疗。初始BMC值占性别和年龄匹配的正常均值的百分比显著降至91.0%（P<0.01），表明HD前慢性肾衰竭患者存在骨矿物质丢失。在HD期间，平均BMC（占初始值的百分比）继续显著下降，1年、2年和3年后分别降至95.1%、92.7%和90.8%，不受年龄、性别或初始BMC值的影响。然而，BMC变化的个体间差异相当大：13例（42%）患者3年内BMC丢失超过10%（“快速丢失者”），而12例（39%）患者BMC丢失低于5%或根本没有丢失。“快速丢失者”组甲状旁腺激素和碱性磷酸酶的血清水平显著更高，此外，其血清磷酸盐和钙磷乘积低于另一组患者（“缓慢丢失者”）。慢性肾盂肾炎患者（9.8%）和多囊肾患者（14.2%）HD 3年期间的平均BMC丢失明显且显著（P<0.02），但慢性肾小球肾炎患者（4.8%）的平均BMC丢失要小得多且不显著。结论是，无法通过性别、年龄、初始BMC、生化参数或诊断来选择HD期间骨矿物质丢失程度高的患者（2例慢性肾小球肾炎患者似乎是“快速丢失者”）。为此，必须采用高精度的BMC测量方法。
