Pattern of renal osteodystrophy in haemodialysis patients in Saudi Arabia

In order to know the pattern of renal osteodystrophy in haemodialysispatients in Saudi Arabia we conducted a multicentre study involving209 patients. The mean age of the patients was 39.4±14(18–70) years, 128 were males and 81 females. All patientswere on acetate dialysate and their mean duration on dialysiswas 3.5 ± 1.5 years. The major symptom was bone and joint pain (25.8%). The meanserum calcium was 2.1 ±0.26 mmol/l, phosphorus 2.0 ±0.36mmol/l, alkaline phosphatase 19.7± 14.6 u/l and parathyroidhormone level was 8.9 ± 3.9mg/ml. The mean serum aluminium(AL) level was 25.4±17.7 µg/l, while that of 1,25vitamin D3 was 8.1±4.2ng/l and of fluoride was 92.2 ±31.4 µg/l. The major radiological finding was osteosclerosis(70%). Dual-photon absorptiometry (DPA) showed low bone mineraldensity (LBM) in 65% of the patients. Forty-one patients had bone biopsies with AL staining of thebiopsies. Of this group, 92% had changes of hyperparathyroidismand 66% of them were pure hyperparathyroidism. Sixty percentof them had variable degrees of AL intoxication. The radiologicalskeletal survey of those patients could detect abnormalitiesin only 46% while 70% of them had abnormal bone mineral density(BMD). In conclusion, osteosclerosis is the commonest radiologicalfinding in our dialysis patients while secondary hyperparathyroidismis the main histopathological diagnosis in bone biopsy, evenin patients with normal skeletal survey. AL intoxication isa significant problem in our population. DPA is more sensitivein detecting bone abnormalities than X-radiography.