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Diyabetik ve Nondiyabetik Orta Derecede Böbrek Yetmezliği Olan Hastalarda Renal Osteodistrofi Parametrelerinin Karşılaştırılması

The Comparison of Renal Osteodystrophy Parameters in Diabetic and Nondiabetic Patient with Moderate Renal Failure

Journal Name:

Publication Year:

DOI: 
10.5262/tndt.2010.1001.05
Abstract (2. Language): 
OBJECTIVE: Renal Osteodystrophy (ROD) is a commonly seen complication of chronic renal failure (CRF). In this study, it was investigated that whether diabetes has an additional deteriorating effect on the ROD parameters in patients with moderate renal failure. MATERIAL and METHOD: This study was carried out in 60 (30 diabetic and 30 non-diabetic) patients with moderate renal failure. Twenty-six healthy subjects were taken as the control group. As ROD parameters, serum calcium (Ca+2) and phosphorus (P) concentrations and alkaline phosphatase (ALP) activities and parathormone (PTH) concentration were measured. RESULTS: When the results of the patient group were compared with those of the control group, the mean serum Ca+2 concentration was found lower (p<0.05), the mean serum P, PTH concentration and ALP activity were found higher (p<0.001). There were no significant differences between the nondiabetic and the diabetic patient groups in terms of serum Ca+2, P, PTH concentration and ALP activity (p>0.05). CONCLUSION: In conclusion, we did not find any significant difference between nondiabetic and diabetic subjects in terms of ROD parameters. Therefore, we speculate that diabetes may not create any risk in patients with moderate renal failure for ROD. However, further prospective and detailed studies comprising more patients also including histological examination are needed for clarifying this situation subject.
Abstract (Original Language): 
AMAÇ: Renal Osteodistrofi (ROD), kronik böbrek yetmezliğinin (KBY) sık görülen bir komplikasyonudur. Bu çalışmada, orta derecede böbrek yetmezliği olan hastalarda diyabetin ROD parametrelerini etkileyip etkilemediği araştırıldı GEREÇ ve YÖNTEM: Bu çalışma, Atatürk Üniversitesi Tıp Fakültesi Hastanesi Nefroloji Polikliniği’nde orta derecede böbrek yetmezliği tanısıyla takip edilen 30 diyabetik, 30 nondiyabetik olmak üzere toplam 60 hasta ve 26 sağlıklı bireyden oluşturulan kontrol grubu üzerinde gerçekleştirildi. Kontrol ve hasta gruplarının serum kalsiyum (Ca+2), fosfor (P), parathormon (PTH) konsantrasyonlarına ve alkalen fosfataz (ALP) aktivitelerine bakıldı. BULGULAR: Hasta grubunun sonuçları kontrol grubuyla karşılaştırıldığında, ortalama serum Ca+2 konsantrasyonu anlamlı düzeyde daha düşük (p<0,05), serum P, PTH konsantrasyonları ve ALP aktivitesi anlamlı düzeyde daha yüksek olarak ölçüldü (p<0,001). Diyabetik KBY’li grup ile nondiyabetik KBY’li grup arasında ortalama serum Ca+2, P, PTH konsantrasyonları ve ALP aktivitesi açısından bir fark bulunmadı (p>0,05). SONUÇ: Diyabetik KBY’li hastalar ile nondiyabetik KBY’li hastaların ROD parametreleri açısından bir farklılık göstermediğini tespit ettik. Orta derecede böbrek yetmezliği olan hastalarda diabetes mellitusun ROD için bir risk oluşturmadığını düşünmekteyiz. Ancak daha fazla hasta ile yapılacak, histolojik incelemelerin de olduğu, prospektif çalışmalara ihtiyaç vardır.
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REFERENCES

References: 

1. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J,
Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan
G: Definition and classification of chronic kidney disease: a
position statement from Kidney Disease: Improving Global
Outcomes (KDIGO). Kidney Int 2005;67: 2089-2100
2. National Kidney Foundation: K/DOQI clinical practice
guidelines for chronic kidney disease: Evaluation, classification,
and stratification. Am J Kidney Dis 2002;39(Suppl 1):S1-266
3. Süleymanlar G, Serdengeçti K, Erek E: Türkiye’de son dönem
böbrek yetmezliğin etyolojisi. Türkiye Klinikleri Dahili Tıp
Bilimleri Dergi 2005; 1(21): 1-8
4. Ravid M, Lang R, Rachmani R, Lishner M: Long-term
renoprotective effect of angiotensin converting enzyme
inhibition in NIDDM. Arch Intern Med 1996; 156: 286-89
5. Horiuchi M, Akishata M, Dzau VJ: Recent progress in
angiotensin II type 2 receptor research in the cardiovascular
system. Hypertension 1999; 33 (2): 613-621
6. Gonzalez EA, Martin KJ: Bone and mineral metabolism
in chronic renal failure. In: Johnson RJ, Feehally J (eds).
Comprehensive Clinical Nephrology. Philadelphia: Mosby,
2003: 873-885
7. Martin KJ, Olgaard K, Coburn JW, Coen GM, Fukagawa M,
Langman C, Malluche HH, McCarthy JT, Massry SG, Mehls
O, Salusky IB, Silver JM, Smogorzewski MT, Slatopolsky
EM, McCann L: Bone Turnover Work Group: Diagnosis,
assessment, and treatment of bone turnover abnormalities in
renal osteodystrophy. Am J Kidney Dis 2004;43:558-565
8. Locatelli F, Cannata-Andía JB, Drüeke TB, Hörl WH, Fouque D,
Heimburger O, Ritz E: Management of disturbances of calcium
and phosphate metabolism in chronic renal insufficiency, with
emphasis on the control of hyperphosphataemia. Nephrol Dial
Transplant 2002;17:723-731
9. Hruska K: New concepts in renal osteodystrophy. Nephrol Dial
Transplant 1998; 13: 2755-2760
10. Silver J, Moallem E, Kilav R, Epstein E, Sela A, Naveh-Many
T: New insights into the regulation of parathyroid hormone
synthesis and secretion in chronic renal failure. Nephrol Dial
Transplant 1996;11(Suppl 3):2-5
11. Spasovski GB, Bervoets AR, Behets GJ, Ivanovski N, Sikole A,
Dams G, Couttenye MM, De Broe ME, D’Haese PC: Spectrum
of renal bone disease in end-stage renal failure patients not yet
on dialysis. Nephrol Dial Transplant 2003;18:1159-1166
12. Gomes CP, Silva MIB, Duarte MEL, Dorigo D, Lemos CC,
Bregman R: Bone disease in patients with chronic kidney
disease under conservative management. Sao Paulo Med J 2005;
123: 83-87
Cengiz Ö ve ark: Diyabetik ve Nondiyabetik Orta Derecede Böbrek Yetmezliği
Olan Hastalarda Renal Osteodistrofi Parametrelerinin Karşılaştırılması
Cilt/Vol: 19, No: 1, 2010, Sayfa/Page: 35-39
38
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
Turkish Nephrology, Dialysis and Transplantation Journal
39
13. Nakai T, Masuhara K, Kanbara N: Bone mineral density decrease
is associated with alkaline phosphatase and carboxy-terminal
parathyroid hormone in hemodialysis patients. Dial Transplant
2002; 31: 788-791
14. Yumita S, Suzuki M, Akiba T, Akizawa T, Seino Y,Kurokawa
K: Levels of serum 1,25 (OH)2 D in patients with pre-dialysis
chronic renal failure. Tohoku J Exp Med 1996;180: 45-46
15. Hilker SH, Dusso AS, Rapp NS, Martin KJ, Slatopolosky E:
Phosphorus restriction reverses hyperparathyroidism in uremia
independent of changes in calcium and calcitriol. Arch Intern
Med 1990; 133: 550-557
16. Inaba M, Okuno S, Nagasue K, Otoshi T, Kurioka Y, Maekawa
K, Kumeda Y, Imanishi Y, Ishimura E, Ohta T, Morii H, Kim
M, Nishizawa Y: Impared secretion of parathyroid hormone is
coherent to diabetic hemodialyzed patients. Am J Kidney Dis
2001; 38 (suppl 1): S139-142
17. Shin SK, Kim DH, Kim HS, Shin KT, Ma KA, Kim SJ, Kwak
YS, Ha SK, Sherrard DJ: Renal osteodystrophy in pre-dialysis
patients: Ethnic difference? Perit Dial Int 1999;19 (Suppl 2):
S402-407
18. Yeung LK, Lin H, Chu P, Tseng CF, Wang JS, Chao TY, Lu KC:
The effect of parathyroid hormone on bone remodeling markers
during maintenance hemodialysis. Fu-Jen Journal of Medicine
2004; 2: 233-238
19. Ha SK, Park CH, Seo JK, Park SH, Kangs W, Choi KH, Lee HY,
Han DS: Studies on bone markers and bone mineral density in
patients with chronic renal failure. Yonsei Med J 1996; 37(5):
350-356
20. Çefle A, Borazan A, Yılmaz A: Hemodiyaliz hastalarında kemik
mineral yoğunluğunda azalmaya neden olabilen risk faktörleri.
İstanbul Tıp Fakültesi Mecmuası 2003;66:42-46
21. Asaka M, Iida H, Entani C, Fujita M, Izumino K, Takata M, Seto
H, Sasayama S: Total and regional bone mineral density by dual
photon absorptiometry in patients maintance hemodialysis. Clin
Nephrol 1992;38:149-153
22. Foldes AJ, Arnon E, Popovtzer MM: Reduced speed of sound
in tibial bone of hemodialyzed patients: Association with serum
PTH level. Nephrol Dial Transplant 1996; 11: 1318-1321
23. Gerakis A, Hadjidakis D, Kokkinakis E, Apostolau T, Raptis S,
Billis A: Correlation of bone mineral density with the histological
findings of renal osteodystrophy in patients hemodialysis. J
Nephrol 2000; 13: 437-443
24. Nakashima A, Yorioka N, Tanji C, Asakimori Y, Ago R, Usui K,
Shigemoto K, Harada S: Bone mineral density may be related
to atherosclerosis in hemodialysis patients. Osteoporos Int
2003;14:369-373
25. Chao SH, Tsai KS, Chieng PU, Lee PH, Lee CJ: Bone mineral
density profile in uremic and renal transplant patients. Transplant
Proc 1994; 26: 2009-2011
26. Eeckhout E, Verbeelen D, Sennesael J, Kaufman L, Jonckheer
MH: Monitoring of bone mineral content in patients on regular
hemodialysis. Nephron 1989; 52: 158-161
27. Hutchison A.J, Whitehouse RW, Boulton HF, Adams JE, Mawer
EB, Freemont TJ, Gokal R: Correlation of bone histology with
parathyroid hormone, vitamin D3 and radiology in end-stage
renal disease. Kidney Int 1993; 44: 1071-1077
28. Linengard B, Johnell O, Nilsson BE, Winklund PE: Studies of
bone morphology, bone densitometry and laboratory data in
patients on maintance hemodialysis treatment. Nephron 1985;
39: 122-129
29. Coen G, Bllanti P, Bonucci E, Calabria S, Costantini S,
Ferrannini M, Giustini M, Giordano R, Nicolai G, Manni M,
Sardella D, Taggi F: Renal osteodystrophy in predialysis and
hemodialysis patients: Comparison of histologic patterns and
diagnostic predivicty of intact PTH. Nephron 2002; 91:103-111
30. Kumeda Y, Inaba M, Ishmura E: Renal osteodystrophy with
diabetic bone disease. Clin Calcium 2003;13(3):299-309
31. Couttenye MM, D’Haese PC, Verschoren WJ, Behets GJ,
Schrooten I, De Broe ME: Low bone turnover in patients with
renal failure. Kidney Int 1999;56 :S70-S76
32. Cundy TF, Humphreys S, Watkins PJ, Parsons V:
Hyperparathyroid bone disease in diabetic renal failure. Diabetes
Res 1990; 14: 191-196

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