Aluminum toxicity in patients undergoing dialysis currently requires bone biopsy for definitive diagnosis. The authors retrospectively reviewed clinical, histologic, and radiographic findings in 63 patients undergoing dialysis. In 30 patients, biopsy specimens were negative for
aluminum toxicity, and in 33 patients, specimens were positive. In 21 of the 30 patients who had a negative biopsy specimen, absence of
aluminum toxicity could be predicted by a high immunoreactive
parathyroid hormone level (greater than 2,000 microliter Eq/ml [2,210 pM]) and fewer than three fractures, by the presence of
osteosclerosis on radiographs, or if serum
aluminum levels were less than 30 ng/ml. None of the patients who had a positive biopsy specimen met these criteria. In 18 of 33 patients who had a positive biopsy specimen,
aluminum toxicity could be predicted by a low immunoreactive
parathyroid hormone level (less than 500 microliter Eq/ml [553 pM]) and more than three fractures, or if serum
aluminum levels were greater than 300 ng/ml. None of the patients who had a negative biopsy specimen met these criteria. Thus, based on the criteria identified, the
aluminum status of 62% of these patients would have been correctly diagnosed.