| Theme | Destructive Spondyloarthropathy in Long-term Hemodialysis Patients | |
|---|---|---|
| Title | Bone and joint involvements in chronic dialysis patients -- From view points of a dialysis doctor | |
| Publish Date | 1998/01 | |
| Author | Seiji Ohira | Kidney Center, Nikko Memorial Hospital |
| Author | Noritomo Itami | Kidney Center, Nikko Memorial Hospital |
| [ Summary ] | Bone and joint involvements related to chronic renal failure have been modified lately by long-term dialysis therapy, resulting in variable and complicated manifestations. Aluminum-related bone disease decreased remarkably chiefly because the dangers of aluminum toxicity in the form of osteomalacia, anemia and encephalopathy are well recognized and aluminum-containing phosphate binders are now contraindicated. Nation-wide analyses revealed that about 70% of dialysis patients showed low serum PTH, which strongly suggested low bone turnover (osteomalacia/adynamic bone disease; ADB). Detailed analyses of ADB remain as future problems to be solved. High bone turnover diseases such as secondary hyperparathyroidism are well controlled by pulse therapy, and so on, with active vitamin D. Nonetheless, parathyroidectomy may be necessary in some cases. Dialysis-related amyloidosis, which results from increased serum PTH levels, is characterized by generalized arthralgia, bone cysts, pathological fractures, carpal-tunnel syndrome, destrucive spodylarthropathy, and so on. Several means of decreasing serum beta2-MG have been tried, somewhat successfully, by modified HDF with specific membranes and beta2-MG adsorption columns. Long-term clinical trials are mandatory for evaluating the effectiveness of these therapies. |
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