The early effects of aluminium deposition and dialysis on bone in chronic renal failure: a cross-sectional bone-histomorphometric study.
Renal osteodystrophy and aluminium deposition in bone were studied in 19 predialysis and 65 short-term dialysis patients at kidney transplantation during a 1-year period by means of histomorphometric analysis of bone biopsies. All but three patients on dialysis had histological bone disease at transplantation. Hyperparathyroidism was more pronounced in predialysis patients, while the prevalence of stainable bone aluminium (aluminium-positive bone) was greater in dialysis patients (77% versus 37%; P less than 0.05). Aluminium even accumulated in bone with high turnover, while extensive aluminium deposition was associated with delayed mineralisation, hyperosteoidosis, and less fibrosis. Aluminium-stained bone surface was correlated with intake of phosphate binders in non-dialysed patients and with dialysis duration in dialysed patients. All patients dialysed for more than 17 months had aluminium-positive bone. Dialysis patients with aluminium-positive bone had less bone volume and were older than those with aluminium-negative bone. Four patients, all with aluminium-stained bone surface greater than 45% and a dialysis duration exceeding 2 years, had symptomatic bone disease. Our policy of early kidney transplantation may have prevented manifest aluminium-related bone disease in a number of other patients.
Dahl
E
E
Surgical Department B, Rikshospitalet (The National Hospital), Oslo, Norway.
Nordal
K P
KP
Halse
J
J
Flatmark
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000535:Aluminum / Q000009:adverse effects* / Q000032:analysis; D001847:Bone Diseases / Q000209:etiology*; D001842:Bone and Bones / Q000737:chemistry / Q000473:pathology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
D000535:Aluminum