RISK-FACTORS FOR RENAL OSTEODYSTROPHY - A MULTIVARIANT ANALYSIS

To assess the risk factors associated with renal osteodystrophy, we ex amined the database of 256 patients who were prospectively studied in three Toronto dialysis centers between October of 1987 and 1989, The p otential risk factors examined included age, sex, type and duration of dialysis, type and dose of phosphate binders, vitamin D treatment, an d history of diabetes mellitus, renal allograft failure, parathyroidec tomy, and bilateral nephrectomy, AH patients had undergone a bone biop sy and were categorized into one of four disease groupings: (1) osteit is fibrosa and mixed bone disease, (2) aluminum bone disease, (3) mild bone disorder, and (4) aplastic bone disorder. The mean (+/- SD) age of the patients at bone biopsy was 57 +/- 15 years, and 62% were men, Forty-five percent of patients were treated by hemodialysis and 55% by peritoneal dialysis, The mean duration of dialysis was 4 +/- 4 years, Twenty-five percent were also diabetic, The most common disorder was the aplastic (or ''adynamic'') bone disorder, found in 34% of patients , Aluminum bone disease was found in 27%, osteitis fibrosa or mixed bo ne disease in 27%, and mild bone disorder in 12% of patients, Cumulati ve intake of aluminum gels was associated with aluminum bone disease, whereas peritoneal dialysis with supraphysiologic calcium concentratio ns, ingestion of calcium carbonate, and diabetes mellitus were associa ted with both mild bone disorder and aplastic bone disorder, These thr ee latter risk factors may be important in predisposing patients to a low bone turnover state through modulation of parathyroid hormone secr etion, Thus, recent increases in the frequencies of these risk factors in dialysis patients are associated with a high prevalence of aplasti c bone disorder. The clinical significance of this bone disorder remai ns to be defined.