ACTA ENDOCRINOLOGICA (BUC)

Renal osteodystrophy and low bone mass are frequently found in patients with end-stage renal disease (ESRD). Our aim was to identify the independent predictors of age - and sex-adjusted bone mineral density (BMD), measured at different traditional sites, in patients with ESRD treated by hemodialysis (HD) or peritoneal dialysis (PD). Patients and Methods. We consecutively assessed 23 patients with ESRD (17 on HD and 6 on PD). Patients treated with 1,25 dihydroxyvitamin D, vitamin D derivates (paricalcitol) or calcimimetics were excluded. Serum parathormone and 25OH vitamin D were measured in all patients. In HD patients all biochemical measurements were done in the day between dialysis sesions. BMD was assessed at following sites: femoral neck, total proximal femur, 1/3 radius, ultradistal (UD) radius and total radius. Radial BMD was assessed in the forearm without arteriovenous fistula. BMD Z-score provided by the manufacturer was used. Results. In patiens undergoing PD the femoral neck BMD Z-score was significantly higher than in HD patients (difference -0.77 DS, 95% CI for difference -1.48 to -0.06). PTH correlated significantly with BMD Z-score at the 1/3 (r=-0.664, p<0.001) and total (r=-0.583, p=0.002) radius levels. Total proximal femur and UD radius BMD Z-scores did not correlate with any of the proposed variables. Years of dialysis, 25OH vitamin D and body mass index did not correlate with BMD Z-score at any site. Conclusion. In patients with ESRD PTH correlates strongly with BMD Z-score at cortical sites. PD seems to be less harmful to BMD than HD.