Kidney Week

Abstract: SA-PO702

Diagnosis of Renal Osteodystrophy by Bone Histomorphometry in Chronic Hemodialysis (HD) Patients

Session Information

• Bone and Mineral Metabolism: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Laowalert, Suthanit, Division of Nephrology, Bangkok, Thailand

Suthanit Laowalert,

• Khotavivattana, Tanatorn, Division of Nephrology, Bangkok, Thailand

Tanatorn Khotavivattana,

• Wattanachanya, Lalita, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, Thailand

Lalita Wattanachanya,

• Luangjarmekorn, Pobe, Chulalongkorn university, Bangkok, Thailand, Thailand

Pobe Luangjarmekorn,

• Udomkarnjananun, Suwasin, Chulalongkorn University, Bangkok, Thailand

Suwasin Udomkarnjananun,

• Katavetin, Pisut, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Pisut Katavetin,

• Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand

Paweena Susantitaphong,

• Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand

Somchai Eiam-Ong,

• Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand

Kearkiat Praditpornsilpa,

Background

Management of secondary hyperparathyroidism has been evolving and requires more investigations. Currently, the relatively “wide” recommended target for intact parathyroid hormone (iPTH) level has proved to be reasonable only in limited circumstances. This study was conducted to determine the prevalence of various types of renal osteodystrophy in Thailand and to investigate the correlation between bone markers and bone histomorphometry to suggest an optimal iPTH level.

Methods

22 chronic HD patients participated in this cross-sectional study. iPTH, serum calcium, phosphate and 25-hydroxyvitamin D and bone turnover markers including tartrate-resistant acid phosphatase-5b (TRAP-5b) and bone specific alkaline phosphatase (B-ALP) were measured. Double tetracycline-labeled iliac crest bone specimens were evaluated for static and dynamic parameters by using specialized program (Osteomeasure^®). The types of bone histomorphometry were classified based on turnover (T), mineralization (M), and volume (V) classification.

Results

Mean age and iPTH were 48±10 years and 523±238 pg/mL, respectively. Median dialysis vintage was 64 months. Adynamic bone disease was the most common bone abnormalities (50%), followed by osteitis fibrosa (40.9%) and mixed uremic osteodystrophy (9.1%). No evidences of osteomalacia and aluminum bone disease were detected. iPTH at the cutoff of 484.5 pg/mL predicted high bone turnover with an area under the receiver operating characteristic curve (AUROC) of 0.86 (95 % CI 0.70-1.0) with the sensitivity and specificity of 0.82 and 0.82 respectively.

Conclusion

Adynamic bone disease remains the most common bone disease among chronic HD patients in Thai population, albeit iPTH levels were close to the upper limit target of KDIGO guideline. Our study suggested that bone biopsy is required as an accurate diagnostic tool and providing guide for the treatment of chronic HD patients with renal osteodystrophy.

AUROC of Bone Biomarker to Distinguish High and Low Bone Turnover

Funding

• Government Support - Non-U.S.