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Nephrol Dial Transplant (1994) 9: 668-674
© 1994 European Renal Association-European Dialysis and Transplant Association

research-article

Aluminium-related osteodystrophy and desferrioxamine treatment: role of phosphorus

V. Jorgetti, N. M. Ricco Soeiro, V. Mendes, R. C. Pereira, M. E. Crivellari, G. Coutris, A. Borelli, M. O. Ribeiro Leite, I. Nussenzweig, M. Marcondes, T. Drüeke and G. Cournot

Laboratorie de Fisiopatologia Renal da Facultade de Medicina da Universidade de Sao Paulo Sao Paulo, Brazil; CNRS URA 583 and INSERM U 90, Hôpital Necker—Enfants Malades et Université Paris V; Service de Biophysique et de Médecine Nucléaire, Hôpital St Antoine Paris, France

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Giulia Cournot, CNRS URA 583, Tour Lavoisier, Hopital Necker—Enfants Malades, 149 Rue de Sevres, 75743, Paris Cedex, France

We investigated (1) the prevalence of aluminium overload among 96 patients with symptomatic bone disease haemodialysed from 1987 to 1989 in the Sao Paulo area, Brazil; (2) the effect of 6 months desferrioxamine (DFO) treatment (1–2 g/week). All patients underwent a first bone biopsy. Aluminium overload (extent of stainable bone aluminium more than 20% trabecular surface) was observed in 74 of 96 patients. Forty overloaded patients were divided into patients with high bone formation rate (BFR) (group 1; n=17) and patients with low BFR (group 2; n=23), and had a second biopsy after DFO therapy. In both groups aluminium surface was reduced after treatment (P<0.001), osteoblast surface (P<0.02-P<0.01) and plasma parathyroid hormone (iPTH) (P<0.01) increased. In group 1 BFR remained high. In group 2 BFR remained low in 16 patients (2a) and increased in seven (P<0.02) (2b). In group 2a plasma phosphorus was below that in group 2b patients, before (P<0.03) and after (P<0.01) DFO. The histological features of group 2a patients resembled hypophos-phataemic osteomalacia, those of group 2b patients aluminium osteodystrophy.

These data show a high prevalence of aluminium overload in Brazilian patients. Low-dose DFO therapy was safe, decreased bone pain, prevented fractures, and reduced stainable bone aluminium. Bone lesions only partially improved, suggesting that low phosphorus intake and/or plasma calcitriol concentrations may have prevented improvement of bone formation and mineralization.

Keywords: aluminium; bone formation; bone mineralization; desferrioxamine; phosphorus; renal osteodystrophy


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A. Falcao Pedrosa Costa, L. Machado dos Reis, M. Custodio Ribeiro, R. Maria Affonso Moyses, and V. Jorgetti
Effects of calcitriol on parathyroid function and on bone remodelling in secondary hyperparathyroidism
Nephrol. Dial. Transplant., April 1, 2003; 18(4): 743 - 749.
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