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Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología Cátedra de Nefrología – Facultad de Medicina Montevideo – Uruguay.

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Presentación del tema: "Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología Cátedra de Nefrología – Facultad de Medicina Montevideo – Uruguay."— Transcripción de la presentación:

1 Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología Cátedra de Nefrología – Facultad de Medicina Montevideo – Uruguay

2 METABOLISMO FOSFOCALCICO (AÑO 1985) CALCIO n = ± 1.3 mg/dlCALCIO n = ± 1.3 mg/dl < 8 mg/dl 14 % < 8 mg/dl 14 % 8 – 9 mg/dl 33 % 8 – 9 mg/dl 33 % 9.1 – 11 mg/dl 51% 9.1 – 11 mg/dl 51% > 11 mg/dl 2% > 11 mg/dl 2%

3 METABOLISMO FOSFOCALCICO (AÑO 1985) FOSFORO n = ± 1.4 mg/dlFOSFORO n = ± 1.4 mg/dl < 5.5 mg/dl 48% < 5.5 mg/dl 48% 5.5 – 7 mg/dl 40% 5.5 – 7 mg/dl 40% > 7 mg/dl 12 % > 7 mg/dl 12 %

4 METABOLISMO FOSFOCALCICO (AÑO 1985) PTH n = 339PTH n = – % 8 – % 1.3 – 5 46 % 1.3 – 5 46 % 5.1 – % 5.1 – % > % > %

5 METABOLISMO FOSFOCALCICO (abril – octubre 2004) n = 2415 M: 59.6 % F: 40.4 % EDAD: 59.8 ± 16.9 años (2 – 94) Ca: 9.03 ± 0.79 mg/dl (5 – 11.5) P: 5.8 ± 1.6 mg/dl (1.3 – 11) FA: 272 ± 222 (15 – 2000) PTHi: 484 ± 533 pg/ml (2.3 – 4000)

6 METABOLISMO FOSFOCALCIO PAUTAS DOQI CALCIO: mg/dlCALCIO: mg/dl FOSFORO: mg/dlFOSFORO: mg/dl PTHi: 150 – 300 pg/ml PTHi: 150 – 300 pg/ml

7 METABOLISMO FOSFOCALCICO (abril - octubre 2004) n = 2415 Calcio < 8.4 mg/dl 20.7 %Calcio < 8.4 mg/dl 20.7 % 8.4 – 9.5 mg/dl 52.6 % 8.4 – 9.5 mg/dl 52.6 % > 9.5 mg/dl 26.8 % > 9.5 mg/dl 26.8 % Fósforo < 3.5 mg/dl 5.5 %Fósforo < 3.5 mg/dl 5.5 % 3.5 – 5.5 mg/dl 39.8 % 3.5 – 5.5 mg/dl 39.8 % > 5.5 mg/dl 54.7 % > 5.5 mg/dl 54.7 % PTHi > 150 pg/ml 29 %PTHi > 150 pg/ml 29 % 150 – 300 pg/ml 21.6 % 150 – 300 pg/ml 21.6 % > 300 pg/ml 49.4 % > 300 pg/ml 49.4 %

8 METABOLISMO FOSFOCALCICO (abril - octubre 2004)

9 Cannata et al* SUN Cannata et al* SUN (n = 7512) (n = 2415) (n = 7512) (n = 2415) PTHi < % 29 % 150 – % 21.6 % 150 – % 21.6 % > % 49.4 % > % 49.4 % P > % 54.7 % * Sólo 9.5% tenían Ca, P, PTHi y PxCa dentro del rango propuesto por las pautas K/DOQI (Cannata et al, JASN 14: 474A, 2003). * Sólo 9.5% tenían Ca, P, PTHi y PxCa dentro del rango propuesto por las pautas K/DOQI (Cannata et al, JASN 14: 474A, 2003).

10 Epidemiology of Renal Osteodystrophy in Uruguay Current indications of bone biopsies H. Caorsi *, I. Olaizola *, L. Labruna #, V. Jorgetti &, G. Acuña *, A. Petraglia *, L. Fajardo *, A. Alvarez *, P Ambrosoni *. * Grupo de estudio del metabolismo Fosfocálcico – Sociedad Uruguaya de Nefrología – Uruguay # Histomorfometría Osea. Instituto de Reumatología, Montevideo - Uruguay & Histomorfometría Osea. Universidad de Sao Paulo, Sao Paulo - Brasil

11 Aims a)To analyze the prevalence of the different types of bone disease over the time in dialysis patients in Uruguay. b)To determine current indication of bone biopsy in the diagnosis of renal osteodystrophy. Bone Biopsies and Clinical Features of Patients 1985 – Bone biopsies from hemodialysis symptomatic patients.167 Bone biopsies from hemodialysis symptomatic patients. 4% Diabetics.4% Diabetics. 93 Female; 74 Male.93 Female; 74 Male. Age: 54 ± 13 years.Age: 54 ± 13 years. Length of dialysis: 53 ± 33 monthsLength of dialysis: 53 ± 33 months

12 Results Frequency of Different Histological Forms 1985 – 2000 Results Frequency of Different Histological Forms 1985 – 2000 n = 167

13 Results Histological Diagnosis According to Year of Bone Biopsies 1985 – HD pts./year: 1187 n = 66 BB HD pts./year: 1187 n = 66 BB HD pts./year: 1602 n = 84 BB HD pts./year: 1602 n = 84 BB HD pts./year: 2254 n = 17 BB HD pts./year: 2254 n = 17 BB % Al in MF: 42.5 ± 47 a % Al in MF : 20 ± 28 a % Al in MF : 27 ± 18 c b a p < 0.001; b p < 0.01; c p < 0.05 % samples [Al]water: 88% (< 10 μg/l) 97% (< 2 μg/l)

14 Results Freqcuency of Adinamic Bone Disease with and without Aluminium Over the Time

15 Renal Osteodystrophy in Uruguay Bone Biopsy Registry iPTH levels iPTH pg/ml OF OMa y ABDa p < 0,001

16 Conclusions Survival rates of patients on dialysis have increased with improve crescent of dialytic therapy, but the resultant increased duration of dialysis has led to rise in hyperparathyroidism. Our results show a significant increase in osteitis fibrosa in the last years. This can be explained by a longer time on dialysis of the patients.Survival rates of patients on dialysis have increased with improve crescent of dialytic therapy, but the resultant increased duration of dialysis has led to rise in hyperparathyroidism. Our results show a significant increase in osteitis fibrosa in the last years. This can be explained by a longer time on dialysis of the patients. On the other hand, low turnover bone disease aluminium related (OM and ABD) decreased significantly, and we find that ABD without aluminium appears in the last period.On the other hand, low turnover bone disease aluminium related (OM and ABD) decreased significantly, and we find that ABD without aluminium appears in the last period. The percentage of aluminium in the mineralization front in bone biopsies has diminished over the time.The percentage of aluminium in the mineralization front in bone biopsies has diminished over the time. The modification of histological forms observed should be related to the improvement in the dialysis water treatment and the reduction of oral aluminium exposure.The modification of histological forms observed should be related to the improvement in the dialysis water treatment and the reduction of oral aluminium exposure.

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