The management of bone and mineral disorders in patients with end-stage renal disease under hemodialysis (Master thesis)
Βουδούρη, Αναστασία/ Voudouri, Anastasia
During chronic kidney disease, mineral homeostasis is disrupted, affecting the entire skeleton and leading to bone disorders. This complication, known as chronic kidney disease-mineral and bone disorders (CKD-MBD), manifests as one or combination of the following: i) abnormalities of calcium, phosphorus, parathormone or vitamin d metabolism, ii) abnormalities in bone turnover, mineralization, volume, linear growth, or strength, ii) vascular or other soft-tissue calcification.
Patients with end-stage chronic kidney disease on dialysis and CKD-MBD are at increased risk of bone fractures, vascular calcification, and cardiovascular events. Therefore, diagnosis, monitoring, and treatment of this syndrome are essential.
The gold standard diagnostic examination for these bone disorders is bone biopsy, although it is invasive and rarely used for routine monitoring. It is indicated in cases of contradictory biomarkers, unexplained bone fractures, persistent bone pain, unexplained hypercalcemia, hypophosphatemia, possible aluminum toxicity, and before therapy with diphosphonates.
To diagnose this syndrome, biomarkers such as parathormone, calcium (total or ionized), phosphate, and alkaline phosphatase (total or bone specific) are utilized. Target levels and monitoring frequencies for these biomarkers are outlined in international guidelines to aid in patient management.
Treatment focuses on maintaining calcium, phosphorus, and parathormone levels within target ranges and managing hyperphosphatemia. This involves restricting dietary phosphorus, ensuring adequate clearance, and using phosphate binders. Vitamin D analogs and/or calcimimetics may be used to suppress parathormone hypersecretion in cases of secondary hyperparathyroidism. Parathyroidectomy is indicated when medications fail to manage secondary hyperparathyroidism.
This study presents the experience of the hemodialysis unit of Papageorgiou General Hospital in Thessaloniki in managing bone and mineral disorders in hemodialysis patients. Biomarkers used in the diagnosis of renal osteodystrophy were recorded on a specific month and compared with target levels proposed by international guidelines to assess goal achievement. Additionally, medications used in managing CKD-MBD during the previous month were documented.
Alternative title / Subtitle: | η εμπειρία ενός κέντρου the experience of a center |
Institution and School/Department of submitter: | Δημοκρίτειο Πανεπιστήμιο Θράκης. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής |
Subject classification: | Chronic renal failure |
Keywords: | Chronic kidney disease,Hyperparathyroidism,Parathormone,Χρόνια νεφρική νόσος,Υπερπαραθυρεοειδισμός,Παραθορμόνη |
URI: | https://repo.lib.duth.gr/jspui/handle/123456789/19123 http://dx.doi.org/10.26257/heal.duth.17847 |
Appears in Collections: | Π.Μ.Σ. ΜΕΘΟΔΟΛΟΓΙΑ ΤΗΣ ΣΥΓΧΡΟΝΗΣ ΑΝΤΙΜΕΤΩΠΙΣΗΣ ΤΗΣ ΝΕΦΡΙΚΗΣ ΑΝΕΠΑΡΚΕΙΑΣ |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
VoudouriA_2024.pdf | Μεταπτυχιακή εργασία | 604.14 kB | Adobe PDF | View/Open |
Please use this identifier to cite or link to this item:
This item is a favorite for 0 people.
https://repo.lib.duth.gr/jspui/handle/123456789/19123
http://dx.doi.org/10.26257/heal.duth.17847
This item is licensed under a Creative Commons License