Prevention of osteitis fibrosa, aluminium bone disease and soft-tissue calcification in dialysis patients: a long-term comparison of moderate doses of oral calcium +/- Mg(OH)2 vs Al(OH)3 +/- 1 alpha OH vitamin D3.
Since 1980, moderately large doses of oral calcium (80 +/- 35 mmol/day as CaCO3 +/- calcium polystyrene sulphonate), in association if necessary with Mg(OH)2 (2.5 +/- 1 g/day), with a reduction in the dialysate Mg concentrations from 0.75 to 0.375 mmol/24 h, have replaced A1(OH)3 as phosphate binders in our centre. A1(OH)3 was previously given to our haemodialysis patients in association with small doses of Ca CO3 (less than or equal to 3 g/day) and if necessary with 1 alpha OH vitamin D3. To compare the long-term efficacy of this new approach with the former one in the prevention of renal osteodystrophy and soft-tissue calcification, 32 current patients were selected on the basis of at least 24 months of treatment in our centre and availability of a yearly bone survey (profile of lumbar spine and anteroposterior view of the pelvis, shoulders and hands). A group of 30 patients treated before 1980 were then selected on the same criteria and matched for age, sex, and duration on dialysis. Linear calcifications of the anterior and posterior walls of the aorta in front of L2, L3, L4 and on the lateral walls of the iliac and femoral arteries were measured and the para-articular calcifications and subperiosteal resorptions of the hands evaluated. The initial extent and the subsequent increase of the ocular and para-articular calcification were comparable in the two groups. Plasma alkaline phosphatase was stable in the normal range in both groups, as was plasma concentration of calcium. Plasma phosphate was slightly elevated (1.7 mmol/l) but stable and comparable in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Morinière
P
P
Hôpital Sud, Amiens, France.
Boudailliez
B
B
Hocine
C
C
Belbrik
S
S
Renaud
H
H
Westeel
P F
PF
Solal
M C
MC
Fournier
A
A
D000535:Aluminum / Q000037:antagonists & inhibitors / Q000633:toxicity*; D000536:Aluminum Hydroxide / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001847:Bone Diseases / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D001842:Bone and Bones / Q000473:pathology; D002114:Calcinosis / Q000473:pathology / Q000517:prevention & control*; D002126:Calcium Hydroxide / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
D006887:Hydroxycholecalciferols; D000536:Aluminum Hydroxide; D000535:Aluminum; D002126:Calcium Hydroxide; C008088:alfacalcidol