| Theme | Orthopedic Diseases Seen in Maintenance Dialysis Patients -- Surgical Indication and Non-indication | |
|---|---|---|
| Title | Physician management of bone and joint disease in dialysis patients | |
| Publish Date | 2010/06 | |
| Author | Satoshi Kurihara | Saitama-Tsukinomori Clinic |
| Author | Fumihiko Yasuda | Saitama-Tsukinomori Clinic/Department of Nephrology, Nippon Medical School |
| [ Summary ] | The causes of bone and joint disease in uremic patients are primarily abnormal metabolism of components such as inorganic phosphate, calcium, vitamin D, or parathyroid hormone induced disorders (CKD-MBD), dialysis-related amyloidosis originating from β2microglobulin (β2MG), and age-related disorders of the bones and joints also play roles in these conditions. CKD-MBD, increases the risk of death not only due to fractures, but also due to cardiovascular events associated with accelerated arterial wall calcification. Mortality risk is especially high in patients on long-term dialysis. To avoid these conditions, physicians should strictly control the serum levels of inorganic phosphorus (3.5-6.0 mg/dl), calcium (8.4-10.0 mg/dl), calcium phosphorus products (below 55 mg2/dl2), and intact-parathyroid hormone (60-180 pg/ml), per the JSDT guideline of 2006. Dialysis related forms of amyloidosis such as carpal tunnel syndrome, bone cysts in the hip and knee joints, and destructive spondyloarthropathy of the vertebral bone inflict a great deal of suffering on long term dialysis patients. Physicians should endeavor to keep serum levels of β2MG low through the use of dialysis techniques, employing high-performance membrane dialyzers, hemofiltration, hemodiafiltration and β2MG adsorption columns. In elderly patients with decreased bone mineral density, effective drug and nutritional treatments should be administered to protect against fractures. |
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