Bone Aluminum Accumulation in Hemodialysis Patients: A Longitudinal Perspective

Serial bone biopsies obtained from 19 chronic hemodialysis patients asymptomatic for bone disease were examined retrospectively. We found only modest amounts of stainable bone aluminum after the first few years of hemodialysis therapy. Over the ensuing 5 to 15 years, there was a progressive increase in stainable bone aluminum (% of total bone surface): 0 to 4.9 years,19.9 ± 3.8% (mean ± SEM); 5.0 to 9.9 years, 28.4 ± 5.3%; and ≥10.0 years, 58.0 ± 7.7%. At final biopsy, the extent of bone surface aluminum was significantly correlated with duration of hemodialysis therapy ( r = 0.54) and with bone formation rate (BFR) ( r = − 0.54). Patients who developed aluminum-associated bone disease did not differ from other patients in duration of hemodialysis, intake of 1-hydroxylated vitamin D3 compounds, or the findings on early bone biopsy. High-turnover renal osteodystrophy remains the dominant bone lesion throughout the couse of hemodialysis in patients with intact parathyroid glands. In individual patients, bone histology frequently changes over time and in some patients, aluminumassociated bone disease may improve spontaneously. Bone biopsy in an asymptomatic patient who has received hemodialysis therapy for