Comparison of skeletal changes related to patients with chronic kidney disease and healthy individuals in digital panoramic radiography

Background: Chronic kidney disease (CKD) is a prevalent condition affecting bone metabolism. Bone changes in CKD patients also known as renal osteodystrophy happen due to disorders in the regulation of water and electrolytes caused by the disease. The aim of this study is to investigate the bone changes of CKD stages 3–5 patients without dialysis using digital panoramic radiography. Materials and Methods: In this cross-sectional study, panoramic radiographs were obtained from 30 patients with CKD stages 3–5 and 30 age and gender matched healthy individuals. The mean values of quantitative parameters such as mental index (MI), panoramic mandibular index (PMI), and antegonial index (AI) were measured and qualitative parameters such as mandibular cortical index (MCI) and trabecular bone pattern (TP) were recorded based on Kelemetti and Lindh calcifications, respectively. Statistical analysis was performed using t-test, Chi-square, and Mann–Whitney test (α = 0.05). Results: The mean values of MI, PMI, and AI in the two groups were not statistically significant (P > 0.05). MCI and TP were significantly different between the two groups. MCI showed more defects in mandibular cortex of CKD patients (6.7% of patients vs. 0% of control group were C3, P = 0.038), and TP showed more porosity in mandibular bone of CKD patients (10% of patients vs. 0% of control group were sparse, P = 0.001). Conclusion: The amount of MI, PMI, and AI were not related to CKD. While MCI and TP were significant parameters that showed mandibular cortical situation and trabecular bone pattern, they assess osteoporosis level in a more reliable manner in CKD stages 3–5 patients without dialysis.

Hiperparatiroidismo secundario en diálisis / Secondary hyperparathyroidism in dialysis

El hiperparatiroidismo secundario es uno de los principales problemas que afectan al paciente con Insuficiencia Renal Crónica. Objetivos: Determinar la prevalencia del hiperparatiroidismo secundario y el tiempo aproximado de diálisis transcurrido hasta el momento de su diagnóstico. Material y método: Estudio prospectivo, transversal, realizado en el hospital “Luis Vernaza” desde septiembre a diciembre de 2003, con un total de 48 pacientes atendidos en el área de Nefrología. Para el Diagnóstico de hiperparatiroidismo secundario se determinó en sangre niveles de calcio, fósforo, fosfatasa alcalina y hormona paratiroidea. Se procedió a diagnosticar con hiperparatiroidismo a aquellos que presentaron niveles de PTH >250pg/ml. Resultados: La prevalencia de hiperparatiroidismo secundario en diálisis es de un 46, específicamente de un 45 para los pacientes sometidos a Hemodiálisis y de un 46 para los pacientes sometidos a diálisis peritoneal. Solo en un 5 (n=1) se evidenció un probable riesgo de calcifilaxia. El Tiempo de diálisis promedio de los pacientes con Hiperparatiroidismo secundario es de 3,38 años para los pacientes sometidos a Hemodiálisis y de un 2,05 años para los pacientes sometidos a DPCA. Conclusión: Todos los pacientes sometidos a Diálisis están en igual riesgo de desarrollar hiperparatiroidismo secundario. Los pacientes en Hemodiálisis no tienen un mayor riesgo de desarrollar Hiperparatiroidismo secundario que aquellos que están sometidos a DPCA. La prevalencia de hiperparatiroidismo secundario fue igual en ambos sexos. Los pacientes sometidos a hemodiálisis manejan niveles más altos de PTH.

Secondary hyperparathyroidism is one of the most common problems that affect patients with chronic renal failure. Objectives: Determine the prevalence of secondary hyperparathyroidism and determine the time that exists between the last dialysis and being diagnosed with secondary hyperparathyroidism. Method and materials: It is a prospective, transversal study done at “Luis Vernaza” Hospital during the period of September to December 2003 with a total of 48 patients that were treated at the Nefrology department. To diagnose Secondary hyperparathyroidism we determined serum levels of calcium, phosphorus, alkaline fosfatase and parathyroid hormone. Patients that had a level of parathyroid hormone of >250pg/ml was diagnosed with hyperparathyroidism. Results: The prevalence of secondary hyperparathyroidism in dialysis is 46. Patients undergoing hemodialysis the prevalence was of 45 and 46 for patients undergoing peritoneal dialysis. The amount of time that the patients with secondary hyperparathyroidism have been undergoing hemodialysis is approximately of 3.83 years. Conclusions: All of the patients in dialysis have the same risk to develop secondary hyperparathyroidism. Patients undergoing hemodialysis do not have a higher risk of developing secondary hyperparathyroidism. The prevalence of secondary hyperparathyroidism was the same in both sexes. The patients that underwent hemodialysis had a higher PTH.