Abstract
Renal osteodystrophy is a grave complication in dialysis patients. In this study, we evaluated the effect of parathyroidectomy (PTX) on secondary hyperparathyroidism (2°HPT) that was resistant to treatment with intermittent high doses of 1-25(OH)2D3 in maintenance dialysis patients with Al-osteodystrophy.
PTX was performed in three patients who had been on hemodialysis for more than ten years and had developed 2°HPT and Al-osteodystrophy as complications. The effect of PTX on metabolic bone disease was evaluated by multiple scanning X-ray photodensitometry (MD/MS), and the following results were obtained:
1. After PTX, elimination of desferrioxamine (ODF)-Al by hemodiafiltration increased ∑GS and the μ' scores, and densitometry bone patterns recovered. 2. In one patient who did not exhibit elimination of DFO-Al after PTX, the ∑GS and μ' scores were significantly decreased before PTX. Elimination of DFO-Al by hemodiafiltration after PTX, however, caused an increase in ∑GS and the μ' scores, and bone densitometry pattern gradually recovered. 3. There was recovery from anemia and cough, and QOL improved as well as recovery from metabolic bone disease. In one case, there was significant recovery of cardiac function.
In conclusion, the elimination of DFO-Al after PTX for 2°HPT resistant to treatment with intermittent high doses of 1-25(OH)2D3 in patients with Al-osteodystrophy induces recovery of metabolic bone disease and recovery of anemia, cough, cardiac function and QOL.
