title: The need and use of a phosphate-enriched dialysate during regular hemodialysis.
abstract: A disabling osteomalacic syndrome seen only during regular hemodialysis is described. Its features include skeletal fractures, pain, suppression of pre-existing hyperparathyroidism, and failure to improve with any of the vitamin-D metabolites. Phosphate depletion may be an important etiological factor but this could not explain all cases. A trial with phosphate-enriched dialysate and 1alphaOHD3 resulted in sustained clinical improvement in 54% of the patients and healing of fractures in 33%. Other etiological factors independent of 1,25(OH)2D3 deficiency and phosphate depletion must be considered. Current, indirect evidence suggests that accumulation of water toxins including aluminium may be important.
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D