Open AccessTHE NEED AND USE OF A PHOSPHATE-ENRICHED DIALYSATE DURING REGULAR HEMODIALYSIS
Author(s) -
Alkis Pierides,
H. A. Ellis,
M. K. Ward,
Pedro Aljama,
J. Dewar,
David Kerr
Publication year - 1977
Publication title -
asaio journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.961
H-Index - 66
eISSN - 1538-943X
pISSN - 1058-2916
DOI - 10.1097/00002480-197700230-00097
Subject(s) - hemodialysis , phosphate , intensive care medicine , chemistry , medicine , biochemistry
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.