Pasadakis P, Thodis E, Manavis J, Mourvati E, Panagoutsos S, Vargemezis V
Democritus University of Thrace, Division of Nephrology, General District Hospital, Alexadroupolis, Greece.
Adv Perit Dial. 1995;11:247-53.
Renal osteodystrophy is a virtually universal complication of chronic renal failure (CRF). Varying degrees of calcium-phosphate metabolism derangement and different types of skeletal damage are observed in CRF for many reasons while the use of dialysis for the management of end-stage renal failure further affects these complications. This study was designed to evaluate the bone mineral density (BMD) that is measured by dual-energy x-ray in three groups of patients: A, 10 patients on continuous ambulatory peritoneal dialysis (CAPD); B, 10 patients on hemodialysis (HD); and C, 10 predialytic patients with advanced CRF. All patients were matched for age, sex, duration of dialysis (> 3 years), and the use of phosphate binders. Biochemical (serum iPTH levels, SAP, Ca, P) and radiological bone studies were compared in the three groups. The majority of predialytic patients had BMD values within the normal range, while the BMD values in PD patients were higher (0.985 g/cm2) in comparison with HD patients (0.949 g/cm2). Some patients, especially in the HD population, showed an increase in BMD with time on dialysis. From all other comparisons, radiological signs of high turnover bone disease and osteopenia were the only variables that were correlated with BMD. All these findings suggest that dialysis affects the bone status and that CAPD patients have better bone mineral metabolism as shown mainly with the use of BMD measurements.
肾性骨营养不良实际上是慢性肾衰竭（CRF）的一种普遍并发症。由于多种原因，在CRF患者中可观察到不同程度的钙磷代谢紊乱和不同类型的骨骼损害，而使用透析治疗终末期肾衰竭会进一步影响这些并发症。本研究旨在评估三组患者通过双能X线测量的骨密度（BMD）：A组，10例持续非卧床腹膜透析（CAPD）患者；B组，10例血液透析（HD）患者；C组，10例晚期CRF的透析前患者。所有患者在年龄、性别、透析时间（>3年）和使用磷结合剂方面进行了匹配。比较了三组患者的生化指标（血清iPTH水平、SAP、钙、磷）和放射学骨研究结果。大多数透析前患者的BMD值在正常范围内，而与HD患者（0.949g/cm²）相比，PD患者的BMD值更高（0.985g/cm²）。一些患者，尤其是HD组的患者，随着透析时间的延长BMD有所增加。在所有其他比较中，高转换骨病和骨质减少的放射学征象是与BMD相关的唯一变量。所有这些发现表明透析会影响骨状态，并且CAPD患者具有更好的骨矿物质代谢，这主要通过BMD测量得以体现。
