Abstract

Forty-one patients on our chronic hemodialysis program were assessed for the degree of progression of bone disease over an average period of 46 months. Seven patients were using a fluoridated dialysate. Four of these seven patients developed a marked increase in osteoid as judged by bone biopsy, while in the nonfluoridated group the amount of osteoid remained within normal limits. In the absence of fluoride, although osteitis fibrosa occurred, it was reversible in 10 out of 12 cases by dihydrotachysterol treatment, and overall there was no evidence of progression of bone disease at the end of the study period.

Excerpt:

In conclusion, we believe our experience indicates that patients maintained on long-term hemodialysis using fluoridated water for periods of years will encounter an unacceptable frequency and degree of osteomalacia. Although some bone disease, in the form of osteitis fibrosa, occurs in patients using nonfluoridated water, this is usually reversible by treatment with dihydrotachysterol. It therefore seems prudent to use nonfluoridated water in long-term hemodialysis.

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