| [ Summary ] |
Susceptibility to fractures is increased across the spectrum of chronic kidney disease patients. Moreover, fractures in patients with end-stage kidney disease result in significantly increased mortality rates. Fractures develop in hemodialysis patients with hyperparathyroidism, osteomalacia, and adynamic bone disease. To date, bisphosphonates are the mainstay for prevention of osteoporotic fractures in men and women with normal kidney function. However, there are no prospective studies which address the safety or efficacy of bisphosphonates in hemodialysis patients. In general, exercise can significantly enhance bone strength at loaded sites in children but not in adults. In addition, patients receiving hemodialysis report a significant degree of immobility due to fatigue. Clinical application of rehabilitative strategies, including therapies for anemia to improve physical functions in patients on hemodialysis, is greatly needed. |