Evidence of increased parathyroid activity on discontinuation of high-aluminum dialysate in patients undergoing hemodialysis.
High-aluminum dialysate exposure has been incriminated in the pathogenesis of vitamin D-resistant osteomalacia in patients undergoing long-term hemodialysis. Parathyroid-mediated osteitis fibrosa is rare in these patients. Thirteen patients undergoing longterm hemodialysis were transferred from a center (Unit A) where water used to prepare dialysate was high in aluminum (100 to 450 micrograms/liter) to a new center (Unit B) where dialysate was highly purified (aluminum concentration less than 10 micrograms/liter), and changes in calcium metabolism were studied over a 12-month period. After transfer of patients to Unit B, serum aluminum levels fell (p less than 0.01), whereas serum immunoreactive parathyroid hormone levels rose (p less than 0.01) over 10 months. Over this time, predialysis serum calcium levels did not alter significantly, whereas postdialysis serum calcium levels declined slightly (p less than 0.05). Serum phosphate levels did not alter. Serum alkaline phosphatase levels rose progressively in Unit B (p less than 0.001). Discontinuation of dialysate high in aluminum in patients undergoing long-term hemodialysis may facilitate a rise in parathyroid activity.
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000535:Aluminum / Q000097:blood / Q000494:pharmacology*; D002118:Calcium / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000201:enzymology / Q000628:therapy*; D008134:Long-Term Care; D008875:Middle Aged; D010280:Parathyroid Glands / Q000187:drug effects / Q000503:physiopathology*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis; D013997:Time Factors
D010281:Parathyroid Hormone; D010710:Phosphates; D000535:Aluminum; D000469:Alkaline Phosphatase; D002118:Calcium