Persistent hypophosphataemia and osteomalacia in dialysis patients not on oral phosphate-binders: Response to dihydrotachysterol therapy
Ahmed, K.Y.; Varghese, Z.; Wills, M.R.; Meinhard, E.; Skinner, R.K.; Baillod, R.A.; Moorhead, J.F.
Lancet 2(7983): 439-442
1976
ISSN/ISBN: 0140-6736 PMID: 73742 Document Number: 98696
Four patients who had been on regular hemodialysis for periods of 3 1/2-7 yr became hypophosphatemic with plasma-Pi concentrations of 2.5 mg/dl or less before dialysis. None of them had been taking oral Pi-binders for 2 yr or more. Histologically all the patients had an excess of osteoid on bone biopsy. Intestinal absorption of Pi and Ca was impaired, despite normal or high serum-25-hydroxycholecaliferol concentrations. Treatment with oral dihydrotachysterol resulted in corrections of the Pi malabsorption and increases in plasma-Pi concentration. The initial low plasma-Pi values in these patients before dialysis probably reflected a state of Pi depletion caused by the combination of malabsorption, loss during dialysis, and a low dietary intake.