Fractures and Osteomalacia in a Patient Treated With Frequent Home Hemodialysis.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Mark R HanudelIsidro B Salusky

Abstract

Bone deformities and fractures are common consequences of renal osteodystrophy in the dialysis population. Persistent hypophosphatemia may be observed with more frequent home hemodialysis regimens, but the specific effects on the skeleton are unknown. We present a patient with end-stage renal disease treated with frequent home hemodialysis who developed severe bone pain and multiple fractures, including a hip fracture and a tibia-fibula fracture complicated by nonunion, rendering her nonambulatory and wheelchair bound for more than a year. A bone biopsy revealed severe osteomalacia, likely secondary to chronic hypophosphatemia and hypocalcemia. Treatment changes included the addition of phosphate to the dialysate, a higher dialysate calcium concentration, and increased calcitriol dose. Several months later, the patient no longer required a wheelchair and was able to ambulate without pain. Repeat bone biopsy revealed marked improvements in bone mineralization and turnover parameters. Also, with increased dialysate phosphate and calcium concentrations, as well as increased calcitriol, circulating fibroblast growth factor 23 levels increased.

Citations

Apr 3, 2018·Current Opinion in Nephrology and Hypertension·Carolina Steller Wagner MartinsRosa Maria Affonso Moysés
Apr 4, 2019·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Minako WakasugiIchiei Narita
Oct 19, 2019·BMC Nephrology·Damien AshbyMartin Wilkie
May 27, 2020·Archives of Orthopaedic and Trauma Surgery·Atsushi EndoMichael J Weaver
Nov 28, 2020·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Sevcan A BakkalogluUNKNOWN European Society for Paediatric Nephrology (ESPN) Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD) and Dialysis wo
Feb 9, 2021·JBMR Plus·Salvatore MinisolaSudhaker D Rao
Feb 16, 2021·Calcified Tissue International·Hanne Skou JørgensenUNKNOWN European Renal Osteodystrophy (EUROD) workgroup, an initiative of the CKD-MBD working group of the ERA-EDTA

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