Research Article

Osteomalacic dialysis osteodystrophy: a trial of phosphate-enriched dialysis fluid.

Br Med J 1978; 1 doi: http://dx.doi.org/10.1136/bmj.1.6104.18 (Published 07 January 1978) Cite this as: Br Med J 1978;1:18
  1. T G Feest,
  2. M K Ward,
  3. H A Ellis,
  4. P Aljama,
  5. D N Kerr

    Abstract

    To assess whether phosphate depletion is an aetiological factor in osteomalacic dialysis osteodystrophy we undertook a prospective trial of phosphate-enriched dialysis fluid, in association with oral 1alpha-hydroxycholecalciferol, for this condition. Thirty patients started the trial; of the 27 who completed more than 6 months' treatment, 14 had iliac crest bone biopsies at the beginning and end of the treatment period. Side effects included pruritus, stiffness, and increase in corneal and vascular calcification. Only one patient showed histological improvement of osteomalacia, and eight deteriorated; in seven the osteitis fibrosa worsened. Myopathy showed some improvement in four patients, but became worse in four. This treatment does not seem to have a place in the routine management of non-hypophosphataemic patients on dialysis.