Renal osteodystrophy in peritoneal dialysis and hemodialysis patients: what is the difference?

Hippokratia 2004, 8(4):173-175

D Yonova, P Dukova
Radiotherapy Dpt, General Hospital “Theagenio”, Theesaloniki, Greece


Background: Two general types of renal osteodystrophy(ROD) are recognized in patients on dialysis, excluding the third, mixed one – high bone turnover ROD (HBT) and low bone turnover ROD (LBT). When the “golden standard” – bone biopsy – can not be used, a complex of serum markers quite successfully replace it: intact parathormone (iPTH), bone alkaline phosphatase (BAP), osteocalcin (OC), reflecting bone formation rate and -crosslaps (BC) – pyridinoline and dioxypiridinoline (DYP) – reflecting bone re-absorption.
Material and methods: We compared the prevalence of HBT or LBT by measuring the above mentioned biochemical parameters in 20 pts on peritoneal dialysis (CAPD) (10 males and 10 females) and 20 hemodialysis (HD) pts, (10 males and 10 females) who were for more than 30 months on dialysis and they were non-diabetics.
Results: The CAPD / HD groups showed 143±55 ng / ml versus 923±451 ng / ml (p < 0.001) iPTH levels, 102±77 u / 1 versus 345±256 u / 1 (p < 0.01) HP levels, 12.3±5.4 ng / ml versus 21.5±7.9 ng / ml (p < 0.05) OC levels, 142±14.1 ng / ml versus 221±66 ng / ml (p < 0.05) PICP levels and 15.8±6.8 ng / ml versus 53.5±24.3 ng / ml (p < -.01) DYP levels.
Conclusion: These findings suggest that there is a significantly higher HBT in pts on HD compared to pts on CAPD and point out the importance of investigation and follow up of each dialysis patient, as HBT and LBT are not definitely the privilege of any kind of extra-renal purification method. The existence of a different LBT subtype in HD pts and lack of it in PD pts may be due to the influence of the artificial HD materials on the production of cytokines, potent to increase bone re-absorption.