KMID : 0811820140180020064
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Journal of Korean Society of Pediatric Nephrology 2014 Volume.18 No. 2 p.64 ~ p.70
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Chronic Kidney Disease-mineral Bone Disorder and Active Vitamin D Analogs for Treating Severe Hyperparathyroidism in Children Receiving Chronic Peritoneal Dialysis
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Kang Eun-Gu
Lee Joo-Hoon Park Young-Seo
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Abstract
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Purpose: The aims of this study were to assess the clinical and laboratory profiles of chronic kidney disease-mineral bone disorder (CKD-MBD) and to assess the effects of treatment of active vitamin D analogs on severe hyperparathyroidism (SHPT) in pediatric patients on chronic peritoneal dialysis.
Methods: This is a retrospective study included 53 patients who had been undergoing dialysis for more than 1 year, between January 2003 and December 2012.
Results: Even after treatment with phosphate binders and active vitamin D analogs, the mean¡¾standard deviation of the percentage of time during peritoneal dialysis that the patients¡¯ serum concentrations of phosphorus, corrected total calcium, and parathyroid hormone (PTH) fell within the Kidney Disease Outcomes Quality Initiative recommended ranges was 25.06¡¾17.47%, 53.30¡¾23.03%, and 11.52¡¾ 9.51%, respectively. Clinical symptoms or radiological signs of CKD-MBD were observed in 10 patients (18.9%). There were significant differences in percentage of time that the serum intact PTH concentration was outside of the recommended range between patients with and without symptoms or signs of CKD-MBD (below recommended range, 11.74¡¾7.37% vs. 40.77¡¾25.39%, P <0.001; above the recommended range, 63.79¡¾27.86% vs. 37.09¡¾27.76%, P =0.022). Of the 25 patients with SHPT, high-dose alfacalcidol treatment was required in 13 patients
that controlled SHPT in 7 of these patients, without marked complications.
Conclusion: Despite our efforts to manage CKD-MBD, patients¡¯ met the recommended ranges from relevant guidelines at a low frequency. The treatment of high-dose active vitamin D analogs was required in about half of the patients with SHPT and effective in about half of them.
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KEYWORD
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CKD-MBD, Peritoneal dialysis, Active vitamin D
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