[Difficulties in renal osteodystrophy treatment in patient undergoing long-term renal replacement therapy--a case study].

Abnormal mineral metabolism and altered bone structure and composition occur early in the course of chronic kidney disease. We present difficulties in renal osteodystrophy treatment in patient undergoing renal replacement therapy for twenty two years (dialysis, transplant, dialysis), which is not in the waiting list for kidney transplant (patient disagreement). Due to failure of conventional therapy of hyperparathyroidism (calcium, phosphate binders, vitamin D) he was needed parathyroidectomy twice. Now he presents a very low PTH level but hyperphosphatemia, hypercalcemia and calcium/phosphate product over upper limit. This disturbances led to extra skeletal calcification (skin, vessels, eyes - "red eyes syndrome", central nervous system). Even now having new phosphate binders we cannot keep plasma phosphate, calcium in normal range, probably due to inadequate diet and non-compliance. Effective therapy is still difficult in this patient.