Role of phosphate depletion and high dialysate calcium in controlling dialytic renal osteodystrophy

The increasing utilization of hemodialysis for long-term maintenance in end-stage renal insufficiency has led to the recognition that hyperparathyroidism and renal osteodystrophy are frequent, if not universal, complications. Although scattered reports have dealt with factors influencing the development of these conditions, there has been little systematic evaluation. Recently, attention has focused on inorganic phosphate retention and on the calcium content of the dialysate bath. Since other reports in this issue of Kidney International will deal with abnormalities of vitamin D metabolism, this paper will only touch on this aspect and will concentrate on calcium (Ca) and phosphate (Pi) per se. An excellent comprehensive review of the entire subject has been published recently by Stanbury [1]