A case off the bell curve: customization of the dialysis prescription--a self-report.
OBJECTIVE
In a 35+-year dialysis patient, a series of spontaneous fractures and a history of severe somatic pains of unknown origin, superimposed on a history of generally adequate laboratory values, prompted an attempt at diagnosis of the cause of the condition. The patient was on a regimen of nocturnal home hemodialysis, a 4-night, 7-hour treatment. Physicians were divided on whether the cause might be neuropathic, muscular or osteopathic.


METHODS
A bone biopsy was conducted to evaluate the integrity of the bones.


RESULTS
The biopsy resulted in a diagnosis of osteomalacia - severe mineral depletion of the skeletal system. This was surprising because the hematologic laboratory values did not seem to indicate this. The calcium level in the dialysate was greatly increased, which was supplemented by moderate inclusion of sodium phosphate.


CONCLUSIONS
The bones strengthened over time, resulting in no further fractures, an easing of general pain, and significantly improved mobility. The results demonstrate that customization of the dialysis prescription should be readily available for hemodialysis, whether treated in-center or at home.
Los Angeles, Calif., USA.
Judy
J
Weintraub
D000293:Adolescent; D002119:Calcium Carbonate; D002130:Calcium Phosphates; D015314:Dialysis Solutions; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D057566:Self Report; D014882:Water-Electrolyte Balance
D002130:Calcium Phosphates; D015314:Dialysis Solutions; C020243:calcium phosphate; D002119:Calcium Carbonate