Dialysis encephalopathy associated with polyvalent ion contamination

The histories of five long term dialysis patients, all of whom showed the characteristic features of dialysis bone disease are considered. One population, on hospital dialysis, also suffered dialysis encephalopathy, whilst the home dialysis population did not. It is postulated that the excessive polyvalent ion content of the water supply to a new hospital building displaced aluminum from the bone stores and precipitated encephalopathy in three patients over three months. The relationship of bone lysis (corticosteroids, immobilisation and orthopaedic procedures) to encephalopathy is considered in the light of this experience.