BONE DISEASE AND H YPERP AR ATH YROI DISM IN CHRONIC RENAL FAILURE: THE EFFECT OF lα‐HYDROXYVITAMIN D3

M. PEACOCK, J. E. AARON, G. S. WALKER, A. M. DAVISON

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Abstract

Plasma biochemistry, iliac crest bone biopsy and calcium and phosphate absorption were performed in ninety patients with chronic renal failure, forty‐one of whom were on maintenance haemodialysis. The studies were repeated in a number of these patients after at least 6 months treatment with 1α‐hydroxyvitamin D3 (lα‐OHD3). Before lα‐OHD3 treatment all patients had some abnormality in bone histology; there was an increase in the osteoid volume, the osteoid and resorbing surfaces and a decrease in the calcification fronts. There was no differences between those on and those not on haemodialysis, although the amount of osteoid increased with the length of dialysis. Plasma parathyroid hormone (PTH) was increased in all patients in the presence of hypo‐normo‐ or hypercalcaemia, but the plasma calcium was higher in the haemodialysed patients. Malabsorption of calcium and phosphorus was present but it was significantly worse in the non‐dialysed patients. Hyperphosphataemia was more marked in the non‐dialysed patients and plasma alkaline phosphatase was raised in a number of patients. Plasma PTH correlated positively with plasma alkaline phosphatase and plasma calcium but was unrelated to any of the bone histology parameters. Treatment with lα‐OHD3 corrected the malabsorption of calcium and phosphorus and cured the proximal myopathy. There was a rise in plasma calcium and phosphate, but the rise in phosphate could be prevented with aluminium hydroxide in most patients. Only in 56% of patients was a rise in plasma calcium associated with a suppression of PTH, which did not fall into the normal range. In twenty‐six patients repeat biopsies on lα‐OHD3 showed improvement in histology. It is concluded that lα‐OHD3 corrects the malabsorption and improves the bone histology and the myopathy of renal failure. Tertiary or autonomous hyperparathyroidism occurred in 44% of patients.

Original languageEnglish (US)
Pages (from-to)73s-81s
JournalClinical Endocrinology
Volume7
DOIs
StatePublished - Dec 1977

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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