Aluminum and renal osteodystrophy A diminishing clinical problem

Aluminum-associated osteomalacia is a serious complication of advanced renal disease. Sources o f aluminum include the water used for hemodialysis and the gastrointestinal absorption o f aluminum from the antacids used to bind dietary phosphorus in an effort to prevent hyperparathyroidism. Definitive diagnosis is made by bone biopsy and staining for aluminum. Noninvasive testing using the deferoxamine challenge test together with serum PTH levels is also of value in many instances. The goal for the future is to eliminate aluminum-related osteodystrophy by the avoidance of aluminum, control of phosphorus with non-aluminum-containing binders, and development of novel approaches to facilitate phosphorus removal by dialysis.