| Theme |
Prescription of Therapeutics and Monitoring for the Dialysis Patients |
| Title |
TDM of endocrine disorder (hormone, insulin, vitamin D3) |
| Author |
Takeo Kamijo |
Second Department of Internal Medicine, Jikei University School of Medicine |
| Author |
Keitaro Yokoyama |
Second Department of Internal Medicine, Jikei University School of Medicine |
| Author |
Takashi Shigematsu |
Sakura National Hospital, Japan |
| [ Summary ] |
End-stage renal disease patients treated with renal replacement therapy exhibit many endocrine disorders in various ways. These are as follows. 1) Disorders in synthesis or activation of hormones of the kidney. 2) Target organ resistance to hormones. 3) Changes in metabolism, catabolism and loss of urinary excretion. 4) Adaptive changes in the endocrine system's uremic state.
When instituting insulin treatment for diabetic ESRD patients (as one type of hormonal therapy), hypoglycemia attacks should be avoided to prevent the deterioration associated with diabetic retinopathy and cerebrovascular dementia. Since the symptoms of hypoglycemia are not very clear, the mild control of blood glucose levels may be recommended. Another hormonal therapy for calcium/phosphorus and bone metabolism is vitamin D dosage. The dosage of calcitriol or alfacalcidol is adjusted to maintain serum calcium and phosphorus within normal ranges. If daily oral calcitriol or alfacalcidol causes hypercalcemia, vitamin D pulse therapy with calcitriol may be chosen as a more effective treatment with less risk of hypercalcemia. Recently, we published a report that said that the gene polymorphism of vitamin D receptor (VDR) gene could affect the bone turnover rate and PTH levels in average hemodialysis patients. Several similar reports have been done concerning the renal osteodystrophy field in relation to ESRD patients. In the near future, gene polymorphism studies may be one useful medical assessment tool for therapeutical procedures and prognosis. |