BONE-DISEASE IN LONG-TERM DIALYSIS

We reviewed the clinical features, laboratory findings, and skeletal a bnormalities of six patients who have been on dialysis therapy for 12 to 20 years (average, 16.7 years), Hemodialysis has been the major the rapeutic modality in five of the six individuals, Ages of the patients ranged from 28 to 67 years (mean, 44.5), Bone biopsy specimens were a vailable for five of the patients. in three of these, the predominant changes in bone were those of osteitis fibrosa. In two patients with s evere osteitis fibrosa, there was a decrease in height, Two patients h ad predominantly osteomalacia, but in one of these, the condition was noted before the initiation of 13 years of chronic ambulatory peritone al dialysis, supplanted 2 years ago by hemodialysis, Total parathyroid ectomies with implants of parathyroid tissue in the forearm were perfo rmed in four of the six patients, All four had, and continue to have, markedly elevated levels of parathyroid hormone (PTH). Symptoms and si gns of amyloidosis of bone have occurred in all six patients, includin g carpal tunnel syndrome in two, bane cysts in three, and presumptive tendon involvement of the shoulder in one patient, The pathogenesis of hyperparathyroidism is described briefly, and appropriate treatment i s summarized. (C) 1996 by the National Kidney Foundation, Inc.