Abstract
Various treatments have been proposed for renal osteodystrophy (ROD) in patients undergoing long-term hemodialysis (HD), but it is difficult to prevent the deterioration of ROD. In the present study, the effects of calcitonin on renal osteodystrophy were examined in hemodialysis patients.
Eighty units of Elcatonin (ECT) was continuously infused at each HD into 59 patients in whom the Al-p level remained above 15 KAU despite administration of vitamin D3 and/or hydroxy-aluminum gel. The effects of ECT on ROD were determined on the basis of laboratory findings, especially the levels of Al-p, endogenous calcitonin (CT), c-PTH, and plasma free hydroxyproline level, which is a parameter of bone resorption, together with the findings of bone roentgenography. The levels of Ca, P, c-PTH and endogenous CT did not change throughout the medication period. The Al-p level slightly decreased but not significantly. The mean plasma free hydroxyproline level in hemodialysis patients was 37.76±25.75nmol/ml, which was significantly higher than that in 40 healthy volunteers (9.12±2.73nmol/ml) (p<0.001). The plasma free hydroxyproline level before ECT administration was positively correlated with the Al-p level (r=0.66, p<0.001). The plasma free hydroxyproline level gradually decreased to a value of 20.71±12.25nmol/ml over a 24-month period, and was significantly lower than that before ECT administration (p<0.05), but still higher than that in healthy volunteers. The ECT medication was especially effective in patients with a high plasma free hydroxyproline level (p<0.01). No adverse reactions due to administration of ECT were recognized, except for nausea and vomiting occurring at the early stage of administration. An improvement in anemia was also noted. From these results, it is suggested that administration of ECT is effective for inhibiting abnormal bone resorption in ROD, and that the level of plasma free hydroxyproline may serue as a good parameter for evaluating the effects of ECT.
