Spectrum of renal bone disease in end-stage renal failure patients not yet on dialysis.
BACKGROUND
During the last few years the spectrum of renal osteodystrophy (ROD) in dialysis patients has been studied thoroughly and the prevalence of the various types of ROD has changed considerably. Whereas until a decade ago most patients presented with secondary hyperparathyroidism (HPTH), adynamic bone (ABD) has become the most common lesion within the dialysis population over the last few years. Much less is known about the spectrum of ROD in end-stage renal failure (ESRF) patients not yet on dialysis.


METHODS
Transiliac bone biopsies were taken in an unselected group of 84 ESRF patients (44 male, age 54+/-12 years) before enrolment in a dialysis programme. All patients were recruited within a time period of 10 months from various centres (n=18) in Macedonia. Calcium carbonate was the only prescribed medication in patients followed up by the outpatient clinic.


RESULTS
HPTH was found in only 9% of the patients, whilst ABD appeared to be the most frequent renal bone disease as it was observed in 23% of the cases next to normal bone (38%). A relatively high number of patients (n=10; 12%) fulfilled the criteria of osteomalacia (OM). Mixed osteodystrophy (MX) was diagnosed in 18% of the subjects. There was no significant difference between groups in age, creatinine, or serum and bone strontium and aluminium levels. Patient characteristics associated with ABD included male gender and diabetes, whilst OM was associated with older age (>58 years).


CONCLUSIONS
In an unselected population of ESRF patients already, 62% of them have an abnormal bone histology. ABD is the most prevalent type of ROD in this population. In the absence of aluminium or strontium accumulation the relatively high prevalence of a low bone turnover as expressed by either normal bone or ABD and OM is striking.
Department of Nephrology, Clinical Center Skopje, University of Skopje, Macedonia.
Goce B
GB
Spasovski
An R J
AR
Bervoets
Geert J S
GJ
Behets
Ninoslav
N
Ivanovski
Aleksander
A
Sikole
Geert
G
Dams
Marie-M
MM
Couttenye
Marc E
ME
De Broe
Patrick C
PC
D'Haese
D000328:Adult; D000368:Aged; D016723:Bone Remodeling; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000145:classification / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D018843:Republic of North Macedonia; D012307:Risk Factors
D003404:Creatinine