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Clin Nephrol. 1983 Dec;20(6):302-7.

Bone mineral content in patients on prolonged maintenance hemodialysis: a three year follow-up study.


Bone mineral content (BMC) was measured annually over a three year period in 31 consecutive patients on maintenance hemodialysis (HD). No patient had received treatment with vitamin D derivatives, anticonvulsants or corticosteroids, nephrectomy or a renal transplant. Initial median BMC value in per cent of sex and age matched normal mean was significantly decreased to 91.0% (P less than 0.01), indicating bone mineral loss in chronic renal failure prior to HD. During HD a highly significant fall in mean BMC (in per cent of initial value) continued to 95.1%, 92,7% and 90.8% after 1, 2 and 3 years, respectively, with no influence of age, sex or initial BMC value. The interindividual variation in BMC changes, however, was considerable: the BMC loss over 3 years exceeded 10% in 13 (42%) patients ("rapid losers") while 12 (39%) patients had a BMC loss below 5%, or no loss at all. The "rapid loser" group had significantly higher serum levels of parathyroid hormone and alkaline phosphatases and, moreover, developed a lower serum phosphate and calciumXphosphorus product than the other group of patients ("slow losers"). The mean BMC loss over 3 years of HD was pronounced and significant (P less than 0.02) in patients with chronic pyelonephritis (9.8%) and polycystic kidney disease (14.2%), but much smaller, and not significant, in patients with chronic glomerulonephritis (4.8%). It is concluded that a selection of patients with a high degree of bone mineral loss during HD is not possible by means of sex, age, initial BMC, biochemical parameters, or diagnosis (2 patients with chronic glomerulonephritis appeared to be "rapid losers"). For that purpose a high-precision BMC method is mandatory.

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