ABSTRACT
AIM: Determine whether bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry can be used as predictor of increased risk of death in hemodialysis patients. MATERIALS AND METHODS: A prospective study was performed of 516 patients with chronic kidney disease treated with hemodialysis (men 265, women 251, mean age 44.811.4 years) who were observed for 5.73.2 years. Before inclusion in the study, in all patients was analyzed bone mineral density using dual-energy X-ray absorptiometry in three standard departments: lumbar vertebrae, proximal femur and distal forearm. The probability analysis of the outcome was carried out using the KaplanMeier method and Cox. RESULTS: During follow-up period 111 (21.5%) patients died, 50.5% from cardiovascular events. Survival analysis by KaplanMeier method allowed to prove the increased risk of death from cardiovascular pathology in hemodailysis patients with low bone mineral density of all evaluated areas. Step-by-step multivariate Cox regression analysis showed that the T score of the femur, showing the difference of BMD of the patient with normal value of BMD for young adult, had the greatest prognostic significance. CONCLUSION: Reduced bone mineral density in patients receiving hemodialysis is associated with an increased risk of death from cardiovascular disease. Dual energy x-ray absorptiometry can be used for assessment of this risk.
Subject(s)
Cardiovascular Diseases , Osteoporosis , Absorptiometry, Photon , Adult , Bone Density , Cardiovascular Diseases/diagnostic imaging , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Osteoporosis/diagnostic imaging , Prospective Studies , Renal Dialysis , Young AdultABSTRACT
AIM: to evaluate the effect of Taqi genotypes of vitamin D receptor (VDR) gene polymorphism on bone mineral density (BMD) and the risk for secondary osteoporosis (OP) in patients on programmed hemodialysis. SUBJECTS AND METHODS: Eighty-two patients treated with long-term hemodialysis were examined. Along with physical examination, osteodensitometry was carried out and VDR gene polymorphism was studied in all the patients. RESULTS: OP in the study skeletal parts was more common in the TT-genotype group. The serum concentration of intact parathyroid hormone and the activity of alkaline phosphatase were also higher in the TT-genotype group. However, the diferences were statistically insignificant between the TT-, Tt-, and tt- genotype groups. BMD was lowest in each study skeletal parts in the TT-genotype group and this difference was statistically significant in the proximal femur, which was estimated by the Z index (p = 0.02). CONCLUSION: The results of the present study confirm the hypothesis that the VRD gene is a genetic determinant of bone metabolism in patients with chronic renal disease who receive long-term hemodialysis.
Subject(s)
Bone Density/genetics , Kidney Failure, Chronic/genetics , Polymorphism, Restriction Fragment Length , Receptors, Calcitriol/genetics , Renal Dialysis , Adult , DNA/genetics , Female , Genotype , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Leukocytes/metabolism , Male , Osteoporosis/etiology , Osteoporosis/genetics , Parathyroid Hormone/bloodABSTRACT
The paper is concerned with a study into the mechanisms of renal interstitial lesions of the secondary character seen in patients afflicted with chronic glomerulonephritis. 120 patients with mesangioproliferative and membranous proliferative glomerulonephritis were examined. The patients were distributed into groups depending on the disease acuity, the degree of glomerular sclerosis and the disease stage. Three major mechanisms of the augmentation of changes in the renal interstice have been revealed: 1) exacerbation of the underlying process; 2) the degree of fibroplastic and sclerotic lesions in the glomerulus; 3) drug sensitization.
