Myth: Administration of active vitamin D metabolites is beneficial in patients with advanced chronic renal failure (pre end-stage renal disease)

Author(s):  
Hanna von Hardenberg
2006 ◽  
Vol 63 (1) ◽  
pp. 27-30
Author(s):  
Natasa Jovanovic ◽  
Mirjana Lausevic ◽  
Biljana Stojimirovic

Background/Aim. The disturbances of active forms of vitamin D synthesis and disturbances in calcium and posphate metabolism develop early in chronic renal failure, when creatinine clearance is about 30 ml/min. Chronic hemodialysis and peritoneal dialysis only partially correct the biochemical environment of patients on chronic renal replacement therapy because of end-stage renal disease. These dialysis modalities can?t significantly affect the endocrine disturbances of chronic renal failure and they have minimal modulatory effect. The management of disturbed calcium (Ca) and phosphate (P) metabolism and the maintainance of Ca ? P product below 4.4 mmol/l thanks to the use of dialysate solutions with the appropriate calcium concentration and the careful dosage of phosphate binders, calcium and active vitamin D metabolits, are extremely important for the prevention of renal osteodystrophy, secondary hyperparathyroidism as well as low-bone turnover disease. The aim of the study was to analyze the plasma levels of calcium, phosphate, albumin, alkaline phosphatase and parathormon (PTH) in 58 patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) from March to August 2003. The use of phosphate binders and the substitution with active vitamin D metabolits were also analyzed. Methods. We examined 58 patients, 30 males and 28 female, mean-age 52 years (range, 26-78 years), affected by end-stage renal disease of the different leading cause. The average time on peritoneal dialysis program was 20 months (2-66 months). Most of the patients were treated by CAPD, while only few of them performed automatic, cyclic or intermittent peritoneal dialysis. Most of the patients used a dialysate with 1.75 mmol/l calcium concentration. Results. The study showed that our patients on chronic CAPD program during several months had normal calcemia, phosphatemia and the level of alkaline phosphatase, and that they had Ca ? P product in the recommended range. PTH serum level ranged from 16 to 490 pg/l in our patients. Conclusion. The study showed that a balanced diet and a correct dosage of phosphate binders, as well as a careful substitution with active vitamin D metabolits render a good control of calcium and phosphate serum balance, as well as an effective prevention of renal osteodystrophy development in the patients on chronic peritoneal dialysis treatment.


1990 ◽  
Vol 11 (9) ◽  
pp. 277-282
Author(s):  
Richard N. Fine

The prognosis of the infant, child, or adolescent with chronic renal failure, defined as an irreversible reduction in glomerular filtration rate, has improved during the past quarter century because of the use of dialysis and renal transplantation. These have prolonged lives in previously fatal situations. Because the potential not only to sustain life but also to effect full rehabilitation exists with the introduction of these treatments, it is now imperative that the multisystem consequences of uremia be either minimized or totally avoided in the pediatric patient with chronic renal failure. The role of the pediatrician in managing the infant, child, or adolescent with chronic renal failure should be directed toward minimizing the potentially devastating consequences of uremia so that the patient is in optimal clinical condition when end stage renal disease occurs. INCIDENCE It is difficult to know the incidence and prevalence of chronic renal failure and end stage renal disease in children. Surveys in Europe and North America have been conducted to obtain precise information regarding these issues; not only have the definitions included in these surveys differed, but the upper and lower age limits defining pediatric patients have not been uniform. The available data suggest a prevalence of chronic renal failure of 18.5 per 1 million child population and an incidence of end stage renal disease of from 3 to 6 children per 1 million total population.


2006 ◽  
Vol 60 (6) ◽  
pp. 734-739 ◽  
Author(s):  
Ana C Simões E Silva ◽  
José Silvério S Diniz ◽  
Regina M Pereira ◽  
Sérgio V Brant Pinheiro ◽  
Robson Augusto S Santos

2003 ◽  
Vol 40 (139) ◽  
pp. 134-138 ◽  
Author(s):  
Sanjib Kumar Sharma ◽  
P Kumar ◽  
A Chapagain ◽  
S Koirala

Dialysis supports life, in spite of complete cessation of renal functions. Haemodialysis(HD) service became available in B. P. Koirala Institute of Health Sciences, Dharansince September 1999. Six hundred and sixty one sessions of HD in 50 patients werecarried out in one year. End stage renal disease (ESRD), acute renal failure (ARF),acute on chronic renal failure constituted 54%, 26% and 20% of the patientsrespectively. Majority of the patients (72%) were between 15 to 50 years of age. Chronicglomerulonephritis, chronic interstitial nephritis, and diabetes nephropathy were themost common causes of ESRD. Recovery following HD was 70% in ARF,whileallpatients of acute on chronic renal failure improved following few sessions of HD.Drop out rate on maintained haemodialysis (MHD) was 52%. The increasing demandof dialysis service in this region is difficult to fulfill due to restricted facilities fordialysis, lack of renal transplantation in Nepal, and economic constraint in the part ofpatients. Primary and secondary prevention of renal diseases by community education,awareness and participation needs emphasis. Key Words: Haemodialysis, End stage renal disease, Acute renal failure,Acute on chronic renal failure.


e-CliniC ◽  
2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Cliff W. Sulangi

Abstract: The procedure of access hemodialysis is a vascular surgical procedure. Vascular access is indicated in patients with end stage renal disease (ESRD) or patients with end stage chronic renal failure and had to take process on hemodialysis. Cimino and AV-Shunt cubiti is two techniques of vascular access operation. This research aims to know the percentage of successful cimino and av-shunt cubiti operation in RSUP Prof Kandou at 2013. This research was conducted using a retrospective descriptive methods. This research subjects were 37 patients. 22 patients with cimino and 15 patient with av-shunt cubiti. The result of this research obtained success percentage use 63,6 % of cimino and the percentage of successful use of av-shunt cubiti is 66,7%. Key words: Vascular access, Ciminom av-shunt cubiti, successful percentage   Abstrak: Prosedur dari akses hemodialisa merupakan prosedur operasi vaskular. Akses vaskular diindikasikan pada pasien dengan end stage renal disease (ERSD) atau pasien dengan gagal ginjal kronik stadium akhir dan harus menjalani proses hemodialisa. Operasi Cimino dan AV-Shunt Cubiti merupakan dua teknik operasi akses vaskular. Penelitian ini bertujuan untuk mengetahui prosentase keberhasilan operasi Cimino dan AV-shunt cubiti pada pasien hemodialisa di RSUP Prof Kandou tahun 2013. Penelitian ini dilakukan menggunakan metode deskriptif retrospektif. Subyek penelitian Berjumlah 37 pasien. 22 pasien operasi Cimino dan 15 pasien dengan AV-Shunt cubiti. Hasil penelitian ini didapatkan Prosentase keberhasilan penggunaan Cimino sebesar 63,6 % dan  prosentase keberhasilan penggunaan AV-Shunt cubiti sebesar 66,7%. Kata Kunci: Akses vaskular, Operasi Cimino, AV-shunt cubiti, prosentase keberhasilan


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