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Biochemical Indices of Renal Osteodystrophy in Dialysis Patients on the Island of Malta

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Abstract.

Objectives: Renal osteodystrophy (ROD) has never been studied on the small Mediterranean island of Malta, which has a largely inbred population. The genetic contribution to the pattern of renal osteodystrophy is being increasingly recognized. We were, thus, interested in studying indices of bone turnover in Maltese end stage renal failure patients. Materials and methods: Sixty unselected patients, representing 65% of all patients undergoing dialysis in the island’s renal unit, were prospectively investigated over a period of 5 months with respect to symptoms, calcium/phosphate chemistry, intact parathyroid hormone (iPTH) and bone alkaline phosphatase (bAP). Bone histomorphometry, which is the gold standard in the diagnosis of ROD, was not within the reach of our small unit. Biochemical markers may not be as sensitive and specific as bone biopsy for individual patient diagnosis of ROD sub-type but they can give a fairly good indication of the spectrum of bone turnover on a population basis. The optimum combination of biochemical marker cut-offs available from studies in the literature was then employed to estimate bone turnover. Results: The following biochemical picture emerged: 42% had iPTH < 79.7 pg/ml (which cut off has a reported specificity of 93.7% for low turnover bone disease), 45% had iPTH > 100 pg/ml and bAP > 10 ng/ml (which combined cut off has a reported specificity of 100% for high turnover bone disease), while 13% could not be classified (ie had intermediate values). Conclusions: Based on biochemical data, the pattern of bone turnover seems to be comparable to the European average. Further indepth study using bone histomorphometry is warranted.

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References

  1. KA. Hruska (1997) ArticleTitleRenal osteodystrophy Baillieres Clin Endocrinol Metab 11 165–194 Occurrence Handle10.1016/S0950-351X(97)80585-X Occurrence Handle9222491

    Article  PubMed  Google Scholar 

  2. M Wang G Hercz DJ Sherrard NA Maloney GV Segre Y. Pei (1995) ArticleTitleRelationship between intact 1–84 parathyroid hormone and bone histomorphometric parameters in dialysis patients without aluminum toxicity Am J Kidney Dis 26 836–844 Occurrence Handle7485142

    PubMed  Google Scholar 

  3. C Jarava JR Armas M Salgueira A. Palma (1996) ArticleTitleBone alkaline phosphatase isoenzyme in renal osteodystrophy Nephrol Dial Transplant 11 IssueIDSuppl 3 43–46 Occurrence Handle8840311

    PubMed  Google Scholar 

  4. B Gomez SuffixJr. S Ardakani J Ju D Jenkins MJ Cerelli GY Daniloff VT. Kung (1995) ArticleTitleMonoclonal antibody assay for measuring bone-specific alkaline phosphatase activity in serum Clin Chem 41 1560–1566 Occurrence Handle7586543

    PubMed  Google Scholar 

  5. JA Kanis AJ. Yates (1985) ArticleTitleMeasuring serum calcium Br Med J (Clin Res Ed) 290 728–729

    Google Scholar 

  6. G Eknoyan A Levin NW. Levin (2003) ArticleTitleBone metabolism and disease in chronic kidney disease Am J Kidney Dis 42 1–201 Occurrence Handle10.1016/S0272-6386(03)00826-6

    Article  Google Scholar 

  7. GA Block TE Hulbert-Shearon NW Levin FK. Port (1998) ArticleTitleAssociation of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study Am J Kidney Dis 31 607–617 Occurrence Handle9531176

    PubMed  Google Scholar 

  8. Y Pei G Hercz C Greenwood et al. (1992) ArticleTitleNon-invasive prediction of aluminum bone disease in hemo- and peritoneal dialysis patients Kidney Int 41 1374–1382 Occurrence Handle1614052

    PubMed  Google Scholar 

  9. S Fletcher RG Jones HC Rayner et al. (1997) ArticleTitleAssessment of renal osteodystrophy in dialysis patients: use of bone alkaline phosphatase, bone mineral density and parathyroid ultrasound in comparison with bone histology Nephron 75 412–419 Occurrence Handle9127327

    PubMed  Google Scholar 

  10. G Coen P Ballanti E Bonucci et al. (1998) ArticleTitleBone markers in the diagnosis of low turnover osteodystrophy in haemodialysis patients Nephrol Dial Transplant 13 2294–2302 Occurrence Handle10.1093/ndt/13.9.2294 Occurrence Handle9761512

    Article  PubMed  Google Scholar 

  11. G Dean M Elian AG Bono Particlede et al. (2002) ArticleTitleMultiple sclerosis in Malta in 1999: an update J Neurol Neurosurg Psychiatry 73 256–260 Occurrence Handle10.1136/jnnp.73.3.256 Occurrence Handle12185155

    Article  PubMed  Google Scholar 

  12. A Torres E. Salido (1997) ArticleTitleVitamin D receptor genotype: its role in bone mass and turnover in non-renal and renal patients Nephrol Dial Transplant 12 1811–1812 Occurrence Handle10.1093/ndt/12.9.1811 Occurrence Handle9380300

    Article  PubMed  Google Scholar 

  13. L Gennari L Becherini A Falchetti et al. (2002) ArticleTitleGenetics of osteoporosis: role of steroid hormone receptor gene polymorphisms J Steroid Biochem Mol Biol 81 1–24 Occurrence Handle12127038

    PubMed  Google Scholar 

  14. P. Lips (1997) ArticleTitleEpidemiology and predictors of fractures associated with osteoporosis Am J Med 103 3S–8S Occurrence Handle10.1016/S0002-9343(97)90021-8

    Article  Google Scholar 

  15. YM Baron M Brincat R Galea AM. Baron (1994) ArticleTitleThe epidemiology of osteoporotic fractures in a Mediterranean country Calcif Tissue Int 54 365–369 Occurrence Handle10.1007/BF00305520 Occurrence Handle8062151

    Article  PubMed  Google Scholar 

  16. MP Marco I Martinez A Betriu et al. (2001) ArticleTitleInfluence of Bsml vitamin D receptor gene polymorphism on the response to a single bolus of calcitrol in hemodialysis patients Clin Nephrol 56 111–116 Occurrence Handle11522087

    PubMed  Google Scholar 

  17. SH Pearce RV. Thakker (1997) ArticleTitleThe calcium-sensing receptor: insights into extracellular calcium homeostasis in health and disease J Endocrinol 154 371–378 Occurrence Handle10.1677/joe.0.1540371 Occurrence Handle9379113

    Article  PubMed  Google Scholar 

  18. T Gohda I Shou M Fukui et al. (2002) ArticleTitleParathyroid hormone gene polymorphism and secondary hyperparathyroidism in hemodialysis patients Am J Kidney Dis 39 1255–1260 Occurrence Handle10.1053/ajkd.2002.33399 Occurrence Handle12046039

    Article  PubMed  Google Scholar 

  19. J Montenegro R Saracho O Gonzalez et al. (1997) ArticleTitleReversibility of parathyroid gland suppression in CAPD patients with low i-PTH levels Clin Nephrol 48 359–363 Occurrence Handle9438094

    PubMed  Google Scholar 

  20. T Shigematsu Y Kawaguchi H Kubo et al. (1996) ArticleTitleLow calcium (1.25 mmol/l) dialysate can normalize relative hypoparathyroidism in CAPD patients␣with low bone turnover Adv Perit Dial 12 250–256 Occurrence Handle8865914

    PubMed  Google Scholar 

  21. MM Couttenye PC D’Haese VO Hoof ParticleVan et al. (1996) ArticleTitleLow serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients Nephrol Dial Transplant 11 1065–1072 Occurrence Handle8671970

    PubMed  Google Scholar 

  22. DJ Sherrard G Hercz Y Pei et al. (1993) ArticleTitleThe spectrum of bone disease in end stage renal failure – an evolving disorder Kidney Int 43 436–442 Occurrence Handle8441240

    PubMed  Google Scholar 

  23. Q Qi MC Monier-Faugere Z Geng HH. Malluche (1995) ArticleTitlePredictive value of serum parathyroid hormone levels for bone turnover in patients on chronic maintenance dialysis Am J Kidney Dis 26 622–631 Occurrence Handle7573017

    PubMed  Google Scholar 

  24. P Ballanti BM Wedard E. Bonucci (1996) ArticleTitleFrequency of adynamic bone disease and aluminum storage in Italian uraemic patients – retrospective analysis of 1429 iliac crest biopsies Nephrol Dial Transplant 11 663–667 Occurrence Handle8671855

    PubMed  Google Scholar 

  25. G Coen P Ballanti E Bonucci et al. (2002) ArticleTitleRenal osteodystrophy in predialysis and hemodialysis patients: comparison of histologic patterns and diagnostic predictivity of intact PTH Nephron 91 103–111 Occurrence Handle10.1159/000057611 Occurrence Handle12021526

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ian Galea, Department of Medicine, St. Luke’s Hospital, Malta

    Ian Galea & Emanuel Farrugia

  2. Ian Galea, CNS Inflammation Group, Cell Sciences, School of Biological Sciences, University of Southampton, Bassett Crescent East, Southampton, SO16 7PX, UK

    Ian Galea

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  1. Ian Galea
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  2. Emanuel Farrugia
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Correspondence to Ian Galea.

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Galea, I., Farrugia, E. Biochemical Indices of Renal Osteodystrophy in Dialysis Patients on the Island of Malta. Int Urol Nephrol 37, 335–340 (2005). https://doi.org/10.1007/s11255-004-4653-0

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  • DOI: https://doi.org/10.1007/s11255-004-4653-0

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