**2.3 Subjects**

48 Chronic Kidney Disease

Marie-Claude 1990). Symptoms of ROD are seen only in about 10% of pre-dialysis patients, but when they have been on dialysis for several years, 90% of them will have symptoms (Sanchez 2001). When glomerular filtration rate (GFR) falls to 50% of normal, more than 50% of patients exhibit abnormal bone histology. As much as 90% of patients with end-stage

The bone disorders associated with chronic renal failure are; Osteitis Fibrosa cystica due to secondary hyperparathyroidism, osteomalacia, osteoporosis. Adynamic osteopathy, skeletal microglobulin amyloid deposit, aluminum related low turnover bone disease and mixed forms of ROD. Osteitis Fibrosa is the commonest form of ROD (Hartmut and Marie-Claude 1990). All these increase the morbidity and mortality in patients with CRF. The prevalence of the different types of ROD may vary depending on aluminum exposure, treatment with Vitamin D metabolites, dietary intake, and whether or not is undergoing dialysis (Hartmut

The diagnosis of ROD can either be by invasive or non invasive methods. The invasive methods include: bone biopsy after double tetracycline labeling, scintigraphical scan studies, computed tomography and bone densitometry (Sanchez 2001). A definitive diagnosis of ROD can only be made with bone biopsy. The non invasive methods employ the use of serum markers of bone metabolism, including bone-specific alkaline phosphatase (bap), pre collagen type 1 carboxy1- terminal extension peptide (PICP), osteocalcin, pyridinoline (PYD), tartrate resistance acid phospatase (TRAPE) and intact parathyroid hormone (IPTH), and skeletal x-ray (Sanchez 2001). Indeed, detection of biochemical makers such as serum bap can predict the presence of ROD. Serum bap is a specific and sensitive marker that is used to evaluate the degree of bone remodeling in uraemic patients (Sanchez 2001, Urena et al, 1991). Also intact PTH and several relatively new bone markers such as PYD and PICP are of immense value in the non-invasive diagnosis of ROD. In patients that do not have liver disease, parathyroid hormone and alkaline phosphatase are less expensive and noninvasive alternatives for evaluation of ROD (Urena et al, 1991). These biochemical markers have the added advantage of allowing for repeated measurements, and therefore make possible the study of short term changes in bone turn over and the effect of treatment (Coen et al 1998). They may be used to predict the risk of fracture (independently of bone loss),

In developing countries like Nigeria, these non-invasive and relatively less expensive methods for evaluating bone changes in CRF patients will be a very useful alternative to the

Because of paucity of data, the prevalence of ROD in Nigeria is not known, however the prevalence of ROD in University of Nigeria Teaching Hospital Enugu using skeletal x-ray was reported to be 3.35% (Odenigbo, 2003). With the increase in the number of patients with CRF requiring or undergoing dialysis across Nigeria, it has becomes necessary to study the

The study was done at the University of Benin Teaching Hospital (UBTH)) Benin City, which is a 420-bedded tertiary hospital with Renal Unit that offers dialysis. Majority of

renal failure on maintenance haemodialysis have abnormal bone history.

Rate of bone loss and also the response to therapy (Coen et al 1998).

extent of ROD in CRF patient with or without dialysis.

**2 Methodology 2.1 Place of study** 

invasive and relatively more expensive method used in developed counties.

and Marie-Claude 1990).

The study group was made up of consecutive chronic renal failure patients attending the University of Benin Teaching Hospital (UBTH).
