ABSTRACT
OBJECTIVE: To investigate the effects of sevelamer carbonate combined with routine treatment on serum inflammatory factors, heme oxygenase-1 (HO-1) and intact parathyroid hormone (iPTH) levels of chronic renal failure (CRF) patients with hyperphosphatemia.METHODS: Totally 60 chronic renal failure patients with hyperphosphatemia in department of renal internal medicine, Tangshan Workers' Hospital during Jan. 2014 to Jan. 2015 were divided into control group and observation group according to random number table, with 30 cases in each group. Control group received routine treatment as reducing blood glucose, lowering blood lipid, lowering blood pressure, reducing phosphorus, protecting kidney. Observation group was additionally given sevelamer carbonate (dose was 0. 8 g, 3 times a day, during meal) on the basis of control group, for 4 weeks. The levels of IL-6, CRP, HO-1, iPTH, Ca and P were compared between 2 groups. The occurrence of ADR was compared between 2 groups. RESULTS: Two cases were withdrewn from the study in each group, finally 28 cases were included in the study in each group. Before treatment, there was no statistical significance in each index between 2 groups (P>0. 05). Compared with before treatment, the serum levels of IL-6, CRP, iPTH and P in 2 groups were decreased significantly after treatment (P<0. 05), while serum level of Ca was increased significantly (P<0. 05); the improvement of above indexes in observation group were more dovious than control group (P<0. 05). There was no statistical significance in the incidence of ADR between 2 groups (P>0. 05). CONCLUSIONS: Sevelamer carbonate combined with routine treatment can effectively reduce the serum levels of IL-6, CRP, HO-1 and iPTH and regulate Ca and P metabolism of CRF patients with hyperphosphatemia with good safety.
ABSTRACT
Objective To analyze the histological changes of bone diseases and to investigate the noninvasive measurements for diagnosing renal osteodystrophy (ROD) in maintenance dialysis patients . Methods Ninety-one patients were selected to receive bone biopsy . The bone samples were stained with HE, toluidine blue and Masson, and were examined with light microscopy . The levels of immunoreactive parathyroid hormone (iPTH), osteoprotegerin (OPG),sRANKL and osteocalcin (OCN) were determined in the patients enrolled from 2004 to 2006 . The level of iPTH was measured by radioimmunoassay . OPG and sRANKL were measured by ELISA,and OCN was measured by chemiluminescence . Results The incidence of ROD in the maintenance patients was 100% . According to the histological appearance, 50 cases (54 .9%) were high turnover bone disease (secondary hyperparathyroid bone disease), 9 cases (9 .9%) were low turnover bone diseases(osteomalacia and adynamic bone disease), and 32 cases(35 .2% ) were mixed bone disease . The level of iPTH in patients with ROD was significantly increased compared with healthy controls . It was the lowest in low turnover bone diseases . There was no difference among three types of ROD . OPG level was significantly increased compared with healthy controls [(2176 .58±1576 .08) pmol/L vs (1310 .46±1254 .00) pmol/L, P＜0 .05] . The level in high turnover bone diseases was higher than that of the healthy controls [(2261 .85±1712 .22) pmol/L vs (1310 .46±1254 .00) pmol/L, P＜0 .05] . There was no difference among three types of ROD .sRANKL level in high turnover bone disease was significantly increased compared with healthy controls [(0 .328±0 .524)pmol/L vs (0 .084±0 .190) pmol/L, P＜0 .05] . OCN level was also higher than that of the healthy controls (P＜0 .05), and the OCN level in low turnover ROD was the lowest among three types of ROD . OCN level in mixed ROD was dramatically increased as compared to low turnover ROD [(226 .633±66 .455) pmol/L vs (193 .03±104 .269) pmol/L, P ＜0 .05] .Conclusions The histological changes of bone disease can be indicated by iPTH level, but the types of ROD can not be distinguished according to iPTH level neither be differentiated by the levels of OPG, sRANKL and OCN . Bone histomorphometry is still the golden standard for diagnosing renal osteodystrophy .