Taipei City Government

A 30-year-old hemodialysis patient often received inadequate dialysis (3 times a week, 2 hours each time, instead of 4 hours) due to a busy work life. Furthermore, a high phosphate diet and irregular taking of phosphate binders (calcium tablets) often led to high serum phosphate accumulation. Without sufficient dialysis, the parathyroid hormone continued to increase, resulting in osteitis fibrosa and causing kneecap fracture and tendon rupture. Finally, the patient was hospitalized for surgery due to a fracture. After receiving normal hemodialysis, regular diet and administration of phosphate binders (calcium tablets), his parathyroid glands gradually returned to normal.
Chen Da-long, director of the Nephrology Department in the Zhongxiao Branch of Taipei City Hospital, says that chronic kidney disease and end-stage renal disease are usually accompanied by several bone lesions, which are collectively referred to as renal osteodystrophy. Types of renal osteodystrophy include: higher turnover bone disease, lower turnover bone disease and mixed bone disease. Serious cases of higher turnover bone disease lead to osteitis fibrosa cystica and bone fracture.
Common clinical symptoms of higher turnover renal bone disease include: skin itching, bone ache, muscle weakness, fracture, atopic soft tissue calcification, etc. Very high calcium-phosphate product value and concentration of parathyroid hormone are also clinically observed. It is generally suggested that iPTH be used to assess the function of the parathyroid glands. When iPTH is three times higher than the normal value, hyperparathyroidism may be suspected.
The methods for controlling serum phosphate value include: sufficient dialysis, phosphate-controlled diet, calcium-based phosphate binders, aluminum-based phosphate binders and phosphate binders without either aluminum or calcium.