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Introduction:
The aim of the study was to identify biomarkers of alteration in bone mineral density (BMD) in patients on haemodialysis (HD) and peritoneal dialysis (PD).Materials and methods:
In a cross-sectional, longitudinal study dual-energy X-ray absorptiometry scans were performed in 146 HD-patients and 28 PD-patients. Follow-up after 14 months (mean) was conducted in 73 patients. As potential biomarkers we investigated parathyroid hormone (PTH), 25-hydroxy vitamin-D, ionised calcium, albumin, phosphate, and total alkaline phosphatases (t-ALP).Results:
Both groups of dialysis patients had lower BMD in the femoral neck (BMDneck) (P < 0.001) and forearm (BMDforearm) (P < 0.001) compared to healthy controls, but comparable BMD in the lumbar spine (BMDspine). BMD did not differ between dialysis types, but patients ever-treated with glucocorticoids had significantly lower BMD, while patients with polycystic kidney disease had higher BMD. BMD correlated with body weight, actual age, age at initiation of dialysis, duration of dialysis and levels of PTH and t-ALP. However, t-ALP only remained associated with low BMDspine after adjusting for other factors (P = 0.001). In the follow-up study all patients had decreased BMD in all three locations, but only for the lumbar spine there was a significant association between BMD and the bone markers t-ALP (P = 0.009) and PTH (P = 0.013).Conclusions:
Both HD and PD patients have low BMD, and increased concentrations of t-ALP is associated BMDspine after adjustment, while PTH and t-ALP is associated with decrease in BMDspine over time. This substantiates the use of these biomarkers in both types of dialysis patients. 相似文献Science educators are increasingly using a historical approach to pedagogy as a way to enable students to understand the process of the construction of science in a more contextualized manner. Considering the meaning of context in a broader sense, this article has two objectives. First, it aims to explore how physics lessons using a Cultural History of Science approach allowed the development of activities that encouraged students to have discussions about science where their own socio-cultural context was considered, referring to Brazilian scientific production. Second, the article to investigate which understandings about scientific practices could be developed by students from in-class discussions inspired by the Cultural History of Science approach focusing on a historical and students’ own social contexts. The historical episode selected to be introduced in their physics lessons was the development of the Leiden jar in Europe, in the eighteenth century, focusing on the quotidian practices and habits that enabled the construction and use of this artifact. The lessons developed from the Cultural History approach seemed to allow the students to understand that science was developed by many different social actors, in sites that exceed the laboratory and by actions performed in various dimensions. The findings suggest that this approach in science teaching can be a strategy to historically contextualize the development of science while allowing students to reflect about the scientific production in their social context.
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