Renal Osteodystrophy:  Some Therapeutic Considerations Relative to Long-Term Dialysis and Transplantation

This communication will review some of the therapeutic considerations of renal osteodystrophy in light of the material presented in this symposium. From the clinical point of view, the problem of renal osteodystrophy is twofold. First is the definition and pathogenesis. The process of skeletal alteration probably starts quite early in the course of renal disease and progresses with further deterioration of renal function. It includes features of vitamin D resistance or lack which would seem susceptible to early therapy. There is, however, a second clinical presentation of renal osteodystrophy that occurs predominantly in patients with advanced and long-standing uremia, and especially in patients whose life is extended by dialysis. Most of our experience with renal osteodystrophy has been with this latter disease—a process which seemingly developed under our direct observation. This form of renal osteodystrophy may progress rapidly, particularly in patients treated with long-term dialysis and seems to be due