RISK FACTORS FOR OSTEOPAENIA AND OSTEOPOROSIS IN CHRONIC HEMODIALYSIS PATIENTS

THE AIM of the study was to identify risk factors for osteopaenia and osteoporosis in patients with end-stage chronic renal failure receiving dialysis treatment. PATIENTSAND METHODS. 71 hemodialysis patients were examined. Mineraldensityinfemoral bones and lumbar L ₂-L ₄ bone was measured by dual-energy X-ray absorptiometry «Lunar DPX-NT». Values of bone mineral density, T-score and Z-score and analogous criteria in groups of healthy subjects of the corresponding gender and age were determined. Osteopaenia and osteoporosis were diagnosed according to T-score criteria. Osteopaenia is defined as a T-score: osteoporosis <-2.5 and osteopenia from -2.5 to -1.0. RESULTS. 30 patients (42.2%) had a reduced bone mineral density and in 8 (11.3%) patients osteoporosis was diagnosed. Frequency OfIumbarfractures(L ₂-L ₄) increased with the decreased Iumbarmineral density (r=-0.32, p=0.006). Females, height, higher level of serum parathyroid hormone (PTH), prolonged menopause period, anemia and great weekly heparin dose (R ²=O.48) were shown to be lumbar osteoporosis risk factors by the results of the stepwise multiple linear regression analysis. The risk factors of femoral neck osteoporosis included body mass index, elderly age, high PTH Ieveland high weekly heparin dose, anemia, low albumin level and insufficient «dialysis dose» (R ²=O.67). Additional risk factors were: serum phosphate level for Ward’s regions (R ²=O.61), serum phosphate Ieve landduration of renal disease longer than 15 yearsfor trochanter region (R ²=O. 62). CONCLUSION. Risk factors for osteoporosis were revealed for patients with end-stage chronic renal failure receiving program hemodialysis treatment. Moreimportantof them were: serum PTH level higher than 600 pg/ml, elderly age, female, body mass index, menopause longer than 4 months, hyperphosphatemia more than 2.5 mmol/l, serum level of albumin less than 35 g/l, anemia, adequate dialysis (weekly KT/ V index less than 3.1) and weekly hepar in dose during the dialysis procedure more than 15 000 units. Knowledge and correction of these disturbances allow the osteoporosis rate and risk of fractures in patients on chronic hemodialysis to be reduced.

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