Renal Bone Disease: 25-year Experience From a Single Center

Disorders of bone mineral metabolism are common in advanced renal failure. These are associated with significant morbidity and mortality. We report our experience on the management of renal bone disease over a period of 25 years. Between 1982 and 2007, 192 patients had bone biopsies. We found that the epidemiology had changed over these 25 years. While hyperparathyroid bone disease remained the predominant histological type (86%), aluminium-related osteomalacia disappeared. Reduced exposure to aluminium due to decreased use of aluminium-based phosphate binder and better water treatment were among the likely causes. Newer forms of adynamic bone disease were non-aluminium-related and likely resulted from factors such as older patients, more diabetics and oversuppression of parathyroid hormone (PTH). Seventy-four patients underwent parathyroidectomy (PTx), which produced satisfactory control of calcium, phosphate and PTH levels with a mean follow-up of 5 years. Intact PTH (iPTH) levels were kept at 2-5 times of normal throughout the study. Post-PTx mean calcium × phosphate products showed remarkable improvement at 3.80-4.58 mmol2/L2. Thirty-two (47%) patients underwent PTx without autoimplantation. Post-PTx iPTH, calcium and phosphate levels were similar between the implantation and no implantation groups. Time to recurrence of hyperparathyroidism was earlier in the implantation group. No fracture was observed in either group after PTx. PTx without implantation should be considered for patients who have a low chance for kidney transplantation.