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Am J Kidney Dis
2002 Feb;39(2):291-6
Conjunctival
and corneal calcification and bone metabolism in hemodialysis patients.
Tokuyama T,
Ikeda T, Sato K, Mimura O, Morita A, Tabata T.
Department of
Ophthalmology, Inoue Hospital, Osaka, Japan. ttokuyama@nifty.com
Conjunctival
and corneal calcification is well recognized as a metastatic
calcification
in patients
undergoing hemodialysis.
In 44 male
hemodialysis patients, we examined the relationship between the severity
of conjunctival and corneal calcification and age; duration of
hemodialysis; serum levels of calcium (Ca), phosphorus (P), intact
parathyroid hormone (iPTH), alkaline phosphatase (ALP), and osteocalcin;
and bone mineral density (BMD). The mean age was 58.3 years (range,
33-79 yr), and the mean duration of hemodialysis was 94.3 months (range,
25-258 mo). The serum level of Ca was 9.6 +/- 0.1 mg/dL, P was 5.9 +/-
0.1 mg/dL, Ca x P was 57.5 +/- 1.2, iPTH was 204.0 +/- 34.6 pg/mL, ALP
was 173.8 +/- 11.8 U/L, and osteocalcin was 62.8 +/- 9.5 ng/mL. Lumbar
BMD was 0.997 +/- 0.022 g/cm2 and radial BMD was 0.642 +/- 0.015 g/cm2.
There was a
significant positive correlation between the severity of conjunctival
and corneal calcification and the duration of hemodialysis (P <
0.0001), the serum levels of P (P = 0.0035), the Ca x P (P = 0.0034),
the iPTH (P = 0.0154), the ALP (P < 0.0001), and the osteocalcin (P =
0.0010), and was negatively correlated with radial BMD (P = 0.0008).
However, the
severity of conjunctival and corneal calcification was not significantly
correlated with age (P = 0.986), serum Ca levels (P = 0.138), or lumbar
BMD (P = 0.449).
Based on these
findings, we suggest that the conjunctival and corneal calcification
developed by excessive serum levels of Ca and P associated with abnormal
bone and mineral metabolism. This resulted in an increased bone turnover
and decreased BDM after prolonged hemodialysis even though efforts were
made to maintain the homeostasis of Ca and P metabolism in hemodialysis
patients by using various therapeutic approaches.
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