Effect of Dialysis Modality on Bone Disease in patient with End Stage Renal Disease

Abstract

The kidney has a vital role in the metabolism of minerals and bone metabolism. It is the target organ of several regulating hormones such as parathormon (PTH) and fibroblast growth factor-23 (FGF-23) and it has an important role in vitamin D activation. Calcium and phosphorus are very important for the biological functions. Abnormalities in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism are common in patients with (CKD). Aim of the work: To compare the effect of online hemodiafiltration (HDF) dialysis versus hemodialysis using high flux dialyzer on bone markers. Patients and Methods: The study was performed on 50 patients in Ain Shams University Specialized Hospital with end-stage renal failure who was on regular hemodialysis using high flux dialyzer and they erer divided into 2 groups , first group (group1) : 25 patients who continued on regular hemodialysis with high flux dialyzer. second group (group 2): 25 patients who were shifted to online HDF. Inclusion criteria were patients with end stage renal disease on regular hemodialysis for > 6 months, their age> 18 years old , no recent infection (normal CRP) , no cardiac or vascular access complication , none of the patients had history of bone disease e.g. fracture or malignancy. Also, patients should have no history of blood transfusion or history of drug intake that can affect bone metabolism as aluminium containing antiacids. Results: patient who were on dialysis using high flux dialyzer had significantly higher marker (b-ALP) and serum phosphorus than patients who were on online HDF. Conclusion: patients on dialysis by online Hemodiafiltration (HDF) has significantly lower levels of bone specific alkaline phosphatase than patients on dialysis with high flux dialyzers which indicates better bone metabolism in patients on online HDF. Also ,online HDF dialysis shows better clearance of phosphorus ,potassium and BUN.