SPECIFICITIES OF THE PHOSFO-CALCIC METABOLISM IN PATIENTS WITH CRONIC RENAL DISEASE IN INITIATING THE ASSISTED SUBSTITUTION OF THE RENAL FUNCTION IN A HEMODIALISIS CENTER IN WESTERN ROMANIA 112

Correspondence to: Mihãilescu Doina, e-mail: mihailescu.doina64@yahoo.com SUMMARY: The chronic renal disease by slow progressive sitruction of the nefrons advances towards cronic renal failure. One of the manifestations of chronic renal failure are the perturbations of the phospho-calcic metabolism. These perturbations worsen with the progression of the alteration of the glomerular filtration rate. The complex perturbations of the phosfo-calcic metabolism cause renal osteodystrophy. These perturbations are represented by hypocalcemia, hyperfosfatemia, and hypersecretion of PTH wich become worse as glomerular filtration decreases. The chronic renal failure patients develop extra-skeletal calcifications both at the level of vessels and at that of soft tissues.We set to ourselves to analyse the specificities of these changes in patients with renal failure at the start of hemodialysis in a hemodialysis center in the western part of this country. MATERIAL AND METHOD: We assessed 30 stage V cronial renal disease patients with GFR blow 10ml/min hospitalized for initiation of renal substitution therapy by hemodialysis in the Hemodialysis Department of the IUCCH during 2009. Of the 30 patients under study 12(40%) were women and 18(60%) were men. RESULTS OBTAINED: In the group under study, the age was 48.83±16.79 years (between 42 and 72 years). The etiology of chronic renal failure was represented by GNC -10 (33%) cases, polycystic kidney – 3 (10%) cases, PNC4 (13%) cases, nephroangiosclerosis 6 (20%) cases, diabetes – 6 (20%) cases and surgically acquired single kidney-1 (4%) case. Of the group studied , 24 (80%) patients were put into family doctor’s clinics and 21 patients underwent calcium and/or alpha D3 therapy. Of these, 19 cases underwent alpha D3 and calcium treatment and 2 cases underwent only calcium therapy. The average value of calcium was 8.58±0.94 mg/dl. It was found that 11(37%) patients, showed hypocalcaemia. The average value of phosphorus was 6.53±1.82 mg/dl. It was noticed that 26 (87%) patients showed hyperphosphatemia and 4 (13%) patients had normal values. The average value of the phosphocalcic product was 56±15.82 mg%. The average value of PTH was 351±228.76 pg/ml. Of the group under study, 10 (33%) cases showed osteoporosis and 10 (33%) cases had osteopenia in the lombar spine, and 7 (23%) showed osteoporosis in the hips. Radiologic examination revealed 6 (20%) cases of vascular calcification revealed by aortic button calcification, the rest showing normal parameters. Echocardiography was performed in 19 patients. It revealed a normal aspect of the valves and of the pericardium in 11 (58%) patients, thickened pericardium with calcifications in 1 (5%) patient, valvular calcifications in 2 (10%) patients, mitral ring calcification in 1 (5%) patient. Our study has revealed the fact that affection of the phosphocalcic metabolism is present in patients with renal failure in pre-dialytic stage. Knowledge of the changes that occur in the phosphocalcic metabolism in patients with renal failure in pre-dialytic stage is important for its correct treatment. Therefore, this study directs our attention towards the vascular and cardiac changes in these patients, offering us the possibility of a correct treatment of arteriosclerosis and of extraskeletal calcifications. D. Mihãilescu1 V. Velciov2