Clinical Study of Percutaneous Puncture Radiofrequency Ablation Guided by CT Image Information Technology in Patients with Secondary Hyperparathyroidism of Uremia

Objective: To investigate the effectiveness and safety of CT-guided percutaneous radiofrequency ablation for the treatment of secondary hyperparathyroidism (SHPT) in chronic renal failure. Methods: Thirty patients with SHPT in our hospital were selected as the study subjects. Preoperative CT examinations confirmed that there were 1 to 4 hyperplastic parathyroid tissues. Under the guidance of CT, radiofrequency ablation of the hyperplastic parathyroid tissues was performed to detect ablation The levels of PTH, blood Ca, and blood P before and after 10 min, 1 d, 1 week, 1 month, 6 months, and 1 year of ablation were observed to observe the improvement of clinical symptoms and the occurrence of complications. Results: First, the patients' blood PTH levels at 10 min, 1 d, 1 week, 1 month, 6 months, and 1 year after ablation were significantly lower than those before the ablation (P < 0.05); 10 min, 1 d, Blood Ca levels at 1 week, 1 month, 6 months, and 1 year were significantly lower than those before ablation (P < 0.05); 10 min, 1 d, 1 week, 1 month, 6 months, and 1 month after ablation The blood P level in 2015 was significantly lower than that before ablation (P < 0.05). Second, the symptoms of bone pain, itching of the skin, muscle weakness, and anorexia were significantly improved after ablation, and hoarseness occurred in 3 cases. The rate was 10%, all of which remitted spontaneously within 1 week after operation; 2 cases of severe hypocalcemia occurred with a rate of 6.6%. All patients had remission after timely calcium supplementation, and all patients did not relapse. Conclusion: CT-guided percutaneous radiofrequency ablation is a safe and effective method for the treatment of SHPT, which can significantly improve the symptoms of renal bone disease and improve the quality of life.

AB0891 BARE TO THE BONE - AN AUDIT OF RENAL BONE DISEASE AGAINST KDIGO GUIDELINES

Background:Chronic kidney disease-mineral and bone disorder (CKD-MBD) is complex and management can be difficult. We aimed to compare management of our CKD patients to 2018 KDIGO guidelines. The guidelines suggest checking calcium and phosphate (Ca/PO4) within 12 mths in CKD 3a and 3b, within 6 mths for CKD 4, and within 3 mths for CKD 5. Parathyroid hormone (PTH) should be checked at baseline in CKD 3a-b, within 12 mths in CKD 4 and within 6mths in CKD 5. Alkaline phosphatase (ALP) should be measured within 12 mths in CKD 4 and 5. 25-(OH)D levels ‘might’ be measured at baseline in CKD 3a to 5D. BMD scanning is suggested if the result will impact treatment decisions. Lateral abdominal X ray is recommended as an alternative to CT for detection of vascular calcification. Calcitriol and vitamin D analogues are no longer routinely advised in CKD 3a-5; 25-(OH)D insufficiency should be corrected as in the normal population.Objectives:To compare management of our CKD patients to 2018 KDIGO guidelinesMethods:We randomly selected 70 patients in whom data was available from renal clinics between May and September 2019.Results:Mean age was 67.3 yrs. 41 male, 29 female. 33 patients had CKD 3a-b; 31 had CKD 4; 6 had CKD 5. Mean duration of CKD was 10.6 yrs. 10 patients were taking activated vitamin D analogues; 13 were taking 25-(OH)D analogues. 25-(OH)D levels ranged from 24-158 nmol/L (mean 65nmol/L). PTH levels ranged from 2- 69pmol/L (mean 23pmol/L). 3 patients were taking bisphosphonates. 44 had previous lumbar spinal imaging; vertebral fractures were evident in 4 (9%). 12 patients had had DXA scans; lowest T score was -2.5. Table 1 - tests within suggested time frames:CKD 3a-3bCKD 4CKD 5Ca/ PO433 (100%)29 (93%)6 (100%)ALP33 (100%)31 (100%)6 (100%)PTH14 (42%) (ever)8 (26%)3 (50%)25-(OH)D8 (24%) (ever)8 (26%) (ever)1 (14%)(ever)Conclusion:Optimum PTH levels in CKD patients are not known, and therapeutic options in CKD-MBD often limited. Nevertheless, our results suggest that bone biochemistry could be checked more consistently in CKD patients. Although detection of vascular calcification may not alter renal management, abdominal imaging provides an opportunity to screen for vertebral fracture, present in a significant number of our patients. The KDIGO guidelines offer a framework to work with our renal colleagues, as many patients will be jointly managed.References:[1]Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney[2]Disease–Mineral and Bone Disorder: Synopsis of the Kidney Disease:[3]Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Int Med 2018Disclosure of Interests:NATALIA CERNOVSCHI: None declared, SHABEENA ZEB: None declared, TRACEY SALTER: None declared, MARK LLOYD Speakers bureau: £700 into department fund

Renal bone disease: a dietitian's perspective

Renal bone disease increases morbidity and mortality in patients with chronic kidney disease by increasing the risk for fractures, osteoporosis and other bone problems and its association with cardiovascular disease, including calcification and arterial stiffness. Treatment of renal bone disease is through a combination of three main methods to reduce phosphate levels: dietary restriction of high-phosphate foods; dialysis clearance; and the use of phosphate binders to prevent its absorption.

Renal bone disease in patients on hemodialysis: an observational study focusing on the variation of calcium metabolism

Background: The aim of this study was to determine the disturbances in the levels of mineral in the body due to hemodialysis at different levels of parathormone levels and to assess its association with the calcium levels.Methods: Study was a cross sectional for the period of 6 months taking ethical approval. Total 255 cases were registered in this study after taking their informed consent. The cases were divided into three groups according to PTH level. Group 1 has 87 subjects with PTH level <250, group 2 has 102 subjects with PTH level 250-650 and group 3 has 66 cases with PTH level >650. The cases were taking hemodialysis for greater than 6 months and have the ages more than 18 years were included in this study. The demographic data includes age, sex dialysis related data like duration of hemodialysis, levels of calcium, phosphorus, albumin, PTH, ALP were observed.Results: Hemodialysis duration were recorded in respective three groups as 7.28±5.71, 6.26±5.56 and 6.15±4.30 days respectively (P=0.319). Calcium was found in group 1, 8.70±0.81, in group 2, 8.39±0.89 and in group 3, 8.76±0.82 (P=0.01). PTH level in three respective group were recorded to be 123.46±74.15, 418.47±115.49 and 1314.67±1188.63 (P <0.001).Conclusions: Present study showed that significant difference was found in mineral levels in patients on hemodialysis with PTH level as well as with alkaline phosphatase level. Nevertheless, no significant difference was found with duration of dialysis and with parameter of albumin.

Renal medicine

This chapter reviews the investigations required for the diagnosis and classification of acute and chronic kidney diseases. Detailed guidance is provided on the choice of methods to measure or estimate the glomerular filtration rate and to quantify albuminuria/proteinuria. It offers a rational approach to the choice of blood and urine tests in the investigation of patients presenting with haematuria, proteinuria, renal tubular dysfunction, and disorders of acid–base balance. It reviews the pertinent radiological investigations used alongside specialist urine and immunology tests to aid diagnosis. There is a detailed review of the rational investigation of patients with recurrent kidney stone disease. Guidance is provided on laboratory investigation of suspected renal bone disease and on the role of renal biopsy in the investigation of kidney disease.

Severe Secondary Hyperparathyroidism in a Hemodialysis Patient: A Case Report from Mongolia

Secondary hyperparathyroidism (SHPT) occurs in patients with chronic renal failure complicated with renal bone disease and soft tissue/vascular calcification. In dialysis patients with severe SHPT, medical treatment may fail and parathyroidectomy (PTX) is indicated for definitive treatment. Severe hypocalcemia from hungry bone disease or postoperative hypoparathyroidism may occur during the postoperative period. We report here a case of severe SHPT in a hemodialysis patient treated with phosphate binders, calcitriol, and calcimimetics but who still required PTX. Severe hypocalcemia with muscle cramps occurred postoperatively. Around 1 year after PTX, anemia and features of SHPT have improved but the patient still has intermittent hypocalcemia with suspected postoperative hypoparathyroidism. Regular comprehensive assessment of calcium and phosphorus levels throughout all stages of chronic kidney disease is vital. The postoperative period of PTX in SHPT patients is critical, requiring monitoring to improve management.

THE SPECTRUM OF RENAL OSTEODYSTROPHY – NOVEL AND OLD PARADIGMS

“Chronic kidney disease-related mineral and bone disorder” is a newly introduced concept which replaced the former term of “renal osteodystrophy” or “renal bone disease”. It highlights the need for understanding the complex relationships among calcium-phosphate axis, bone metabolism, ectopic calcification and cardiovascular morbidity and mortality in patients with chronic kidney disease. It has the merit to shift the focus from monitoring and treating separate biochemical abnormalities at all costs to the greater aim of improvement survival and reducing major cardiovascular events. However, mainly because of the lack of reliable assessment tools, the bone disorders component is discussed to a much lesser extent even it accounts for major physical disabilities and result in significant impairment of the quality of life. Therefore, the current review aimed to briefly remind the older and newer knowledge in the field of bone changes that occur during the course of chronic kidney disease.