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Histological renal osteodystrophy, and 25 hydroxycholecalciferol and aluminium levels in patients on continuous ambulatory peritoneal dialysis



Histological renal osteodystrophy, and 25 hydroxycholecalciferol and aluminium levels in patients on continuous ambulatory peritoneal dialysis



Kidney International 23(1): 15-21



Of 20 paired bone biopsy specimens, 11 showed significant improvement in osteitis fibrosa (OF) 4 to 14 months after continuous ambulatory peritoneal dialysis (CAPD), during 5 of which patients were treated with 1 alpha -hydroxycholecalciferol, and in 5 patients at 2 years there was no significant deterioration. Six patients without OF at the start of treatment were not changed at 12 months, whereas one patient developed osteomalacia (OM) after parathyroidectomy. Those patients, managed on calcium carbonate supplements and in most no aluminium-containing phosphate binders (ACPB), maintained normal serum ionized and total calcium values whereas mean serum phosphate values ranged between 1.5 and 1.8 mmol/litre on a dialysate Ca of 1.75 mmol/litre. There was a decline in parathyrin in all but 10 patients, 6 of whom with previous severe OF on haemodialysis required parathyroidectomy. 25-Hydroxycholecalciferol values declined to below normal, related to losses in the peritoneal dialysis (PD) fluid in most patients. Mean serum Al values were higher than those in normal controls; those may have been related to Al in the PD fluid. Values increased further when ACPB were introduced. One patient with Al toxicity from earlier exposure was treated with deferoxamine parenterally with the removal of the chelated Al in the PD fluid. CAPD seemed to achieve good control of renal osteodystrophy, but 25-hydroxycholecalciferol values were low and cautious amounts of vitamin D replacement treatment may be necessary. Serum Al values were high and that may be related to the PD fluid Al content.

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Accession: 001085264

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PMID: 6834691


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