FACTORS ASSOCIATED WITH THE DECREASED MINERAL DENSITY OF BONES OF DIFFERENT PARTS OF THE SKELETON IN HEMODIALYSIS PATIENTS

THE AIM of the investigation was to determine factors associated with the development of osteopenia and osteoporosis of different parts of the skeleton in chronic hemodialysis patients besides the indices of phosphoro-calcium metabolism. PATIENTS AND METHODS. Dual X-ray absorptiometry of 3 parts of the skeleton with the estimation of the bone mineral density (BMD) by Z-criterion was fulfilled in 58 patients (m/w - 29/29, mean age 49.8 ± 13.3 years (X±SD) treated by chronic bicarbonate hemodialysis (HD) on average for 74.3±70.1 months. Genetic polymorphism of the vitamin D3 receptor was studied in 30 patients. Under estimation there were the duration of menopause in women, the presence of viral hepatitis В and C, intensity of smoking, alcohol abuse, physical activity, therapy with glucocorticosteroids (GCS) and cytostatics (CS), history of transplantation of the kidneys. RESULTS. BMD of the lumbar vertebra is influenced by genetic polymorphism of the vitamin D3 receptor TAQI: in tt genotype BMD was higher as compared with Tt and TT (F=3.39, _Panova =0.049). In addition, a direct correlation between BMD and the number of blood leukocytes (Rs=0.33; p= 0.015) was also determined. BMD of the proximal part of the femur was higher in patients with greater body mass (Rs=0.57; p<0.001), greater number of leukocytes (Rs=0.35; p=0.012). BMD of the forearm wasdependent on many factors. The negative feedback was found with the duration of HD(Rs=-0.49; p<0.001), duration of GCS therapy (Rs=-034; p=0.028), and CS therapy (Rs=-0.54; p<0.001), allotransplantations of the kidneys in anamnesis (Rs=0.41; p=0.002), the presence of viral hepatitis В and С or their combination (Rs=-0,35; p=0.009), high level of blood ALT (Rs=-0.39; p=0.004) and positive: with the cholesterol level (Rs+0.45; p<0.001) and blood albumin (Rs=0.37; p<0.012). The number of blood leukocytes and the presence of viral hepatitis (Rs=0.54; p<0.001) were associated with the duration of HD. CONCLUSION. A relationship was revealed between BMD of the vertebra and the genetic polymorphism of the vitamin D3 receptor. BMD oftheforearm correlated with a great number of factors: duration of hemodialysis treatment, GCS and CS therapy, the presence of allotransplantations of the kidneys in anamnesis, certain laboratory indices of the nutritional status.

1. Moe S, Drueke T, Cunningham J et al. Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69: 1945–1953

2. Taal MW, Roe S, Masud T et al. Total hip bone mass predicts survival in chronic hemodialysis patients. Kidney Int 2003; 63(3): 1116-1120

3. Matsubara K, Suliman ME, Qureshi A et al. Factors associated with bone mineral density in CKD patients. Nephrol Dial Transplant 2005; 20 [suppl 5]: v84

4. Tomanoski V, Taleska N, Kovaceska V et al Vascular calcifications in haemodialysis patients with different types of renal osteodystrophy-the role of calcitonin. Nephrol Dial Transplant 2006; 21[suppl 4]: iv409

5. Kirkpantur A, Altun, Yilmaz R et al. The association of bone mineral density with coronary artery calcification in maintenance hemodialysis patients.Nephrol Dial Transpl 2006; 21[suppl 4]: iv445

6. Rodriguez GM, Naves DM, Cannata AJB. Bone metabolism, vascular calcifications and mortality: associations beyond mere coincidence. J Nephrol 2005; 18(4):458-463

7. Fedak D, Kuzniewski M, Sulowicz W et al. Looking for association between vascular calcifications and bone mineral density in hemodialysed patients with end stage renal disease (ESRD). Nephrol Dial Transplant 2006; 21[suppl 4]: iv412

8. Moe SM. Vascular calcification and renal osteodystrophy relationship in chronic kidney disease. Eur J Clin Invest 2006; 36 [Suppl 2]: 51-62

9. Fernandez E, Fibla J, Betriu A et al. Association between vitamin D receptor gene polymorphism and relative hypoparathyroidism in patients with chronic renal failure. J Am Soc Nephrol1997; 8(10):1546-1552

10. Akiba T, Ando R, Kurihara S et al. Is the bone mass of hemodialysis patients genetically determined. Kidney Int Suppl 1997; 62: S69-71

11. Karkoszka H, Chudek J, Strzelczyk P et al.Vitamin D receptor gene polymorphism and the rate of bone loss of the femur neck and lumbar spine in hemodialized patients with chronic renal failure. Pol Merkuriusz Lek 1998; 5(28): 199-202

12. Falkiewicz K, Bidzinska B, Demissie M et al. Influence of vitamin D receptor gene polymorphisms on secondary hyperparathyroidism and bone density after kidney transplantation. Transplant Proc 2005; 37(2): 1023-1025

13. Langdahl BL, Gravholt CH, Brixen K, Eriksen EF. Polymorphisms in the vitamin D receptor gene and bone mass, bone turnover and osteoporotic fractures. Eur J Clin Inves 2000; 30(7): 608-617

14. Nagaba Y, Heishi M, Tazawa H et al. Vitamin D receptor gene polymorphisms affect secondary hyperparathyroidism in hemodialyzed patients. Am J Kidney Dis 1998; 32(3): 464-469

15. Yokoyama K, Shigematsu T, Tsukada T et al. Apa I polymorphism in the vitamin D receptor gene may affect the parathyroid response in Japanese with end-stage renal disease. Kidney Int 1998; 53(2): 454-458

16. Bell NH, Morrison NA, Nguyen TV et al. ApaI polymorphisms of the vitamin D receptor predict bone density of the lumbar spine and not racial difference in bone density in young men. J Lab Clin Med 2001; 137(2): 133-140

17. Joki N, Hase H, Imamura Y. Bone mineral density and vascular calcification. Clin Calcium 2005; 15(7): 131-136.

18. Barnas U, Schmidt A, Seidl G et al. A comparison of quantitative computed tomography and dual X-ray absorptiometry for evaluation of bone mineral density in patients on chronic hemodialysis. Am J Kidney Dis 2001; 37(6): 1247-1252

19. Kusec V, Smalcelj R, Cvijetic S. Parathyroid hormone and bone mass after kidney transplantation. Acta Med Croatica 2002; 56(1): 17-20

20. Stein MS, Packham DK, Ebeling PR et al. Prevalence and risk factors for osteopenia in dialysis patients. Am J Kidney Dis 1996; 28(4): 515-522

21. Михеева ЮС, Румянцев АШ, Есаян АМ, Балашов АТ. Факторы риска развития остеопении и остеопороза у больных на хроническом гемодиализе. Нефрология 2003; 7(4): 34-39

22. Kiyotaka K, Jiro U, Hironaka K et al. Association between vitamin D receptor gene polymorphisms and renal osteodystrophy in patients on maintenance hemodialysis. Yonago Acta medica 2000; 43: 27–38

23. Yucel AE, Kart-Koseoglu H, Isiklar I et al. Bone mineral density in patients on maintenance hemodialysis and effect of chronic hepatitis C virus infection. Ren Fail 2004; 26(2): 159-164