Studies on Depression of Immunological Capacity and Metabolic Bone Disease in Patients in Long-term Hemodialysis : II. Metabolic Bone Diseases in Patients on Long-term Hemodialysis

Studies of calcium and bone metabolism disorders were carried out in 54 patients with chronic renal failure undergoing hemodialysis. The results obtained are as follows. 1. The serum Ca level before hemodialysis in patients with chronic renal failure was low compared with healthy individuals. 2. The serum Ca level in these patients rose transiently immediately after hemodialysis but returned to the former low level before the following hemodialysis which was administered 2 to 3 days later. Such hypocalcemia can be improved to some extent by raising the Ca concentration of the dialysate. 3. When these patients were placed on hemodialysis with dialysate with a Ca concentration adjusted to 3.5 mEq/L and at the same time administered 1 α-OH-D3, an analogue of vitamin D preparation, it was possible to keep their serum Ca level almost in the normal range. Hypocalcemia in patients maintaining hemodialysis can be prevented to a considerable degree in this way. 4. Roentgenograms revealed bone lesions such as osteitis fibrosa, osteoporosis, osteomalacia and occasionally osteosclerosis in 30 out of 54 hemodialysis patients. The resorption and disappearance of the lamina dura of the teeth was also observed in 20 out of 54 patients. The CT value for occipital bone (EMI number), second metacarpal index (MCI) and clavicular index (CS) were useful for diagnosis of these bone lesions. These values were below those of the healthy controls. 5. Various types of metastatic calcifications were observed in roentgenograms of 12 out of 54 patients. 6. An improvement in X-ray findings of osteitis fibrosa was observed by the combinational use of hemodialysis and oral administration of 1α-OH-D3. The fact suggests that hemodialysis does not have much influence on the advance of bone lesions. Rather, there is a possibility that the occurrence of bone lesions will be reduced by hemodialysis itself.