Adynamic bone disease with negative aluminium staining in predialysis patients: prevalence and evolution after maintenance dialysis

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Abstract
Aplastic bone disease (ABD) is a common form of renal osteodystrophy and is characterized by a defect in bone matrix formation and mineralization without an increase in osteoid thickness. The prevalence and pathogenesis of ABD in predialysis patients is largely unknown. We prospectively studied 92 unselected predialysis patients with a creatinine clearance 2 and a mean age of 45±2 years (61 M, 31 F). None of the study patients had received any form of vitamin D therapy, and CaCO3 was the primary phosphate binder. Aplastic bone disease was observed in 30 (32%) patients. Stainable bone aluminium surface was PPPPP=0.1). A second bone biopsy was obtained in eleven ABD patients after a period of 16.6±2.2 months on maintenance dialysis with a dialysate calcium of 7 mg/dl. Bone histology was unchanged in 10 patients, and one evolved to mild hyperparathyroidism. Trabecular bone volume did not change (22.7± 1.7 versus 20.7±1.7%), and the stainable bone aluminium surface remained <3%. In summary, ABD not associated with positive histological staining for aluminium is a common finding in asymptomatic end-stage renal failure patients in the Canary Islands. Older age and relatively low PTH values are associated with this form of bone disease. After a period of 12–36 months of dialysis, progressive osteopenia and other clinical problems do not occur.

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