Aluminum intoxication has been a ma-jor cause of morbidity and mortality in dia-lyzed uremic patients.During the last 7-years means to markedly reduce aluminumexposure in this population have been im-plemented.This study was carried out to de-termine how effective restriction of alu-minum exposure has been in preventing alu-minum loading and toxicity in uremic pa-tients.Methods All bone histology processed onpatients with end-stage renal disease(452patients)between January 1984 and Decem-ber 1991 were reviewed.Histomorphometricstudies were performed and bones dividedinto four major grouping:①high turnover,osteitis firosa;②low turnover,osteomala-cia;③low turnover,adynamic and ④mixedtype bone disease.Results Between 1985 and 1991 a signifi-cant decrease in aluminum loading wasfound in patients with end-stage renal dis-ease as determined by a fall in plasma alu-minum from 74±30 μg/L to 12±7 μg/L and decrease in aluminum positive bonespecimens from 87.2% to 35.8%(P<0.01).With the reduction in aluminumloading low turnover osteomalacic bone dis-ease decreased from 11.6% to less than 5%(P<0.05)of the total bone specimensstudied and the fraction of mixed bone dis-ease with osteomalacic features decreasedfrom 33% to 19%(P<0.03).There was nochange in the other types of bone disease.Conclusions The present methods of limit-ing aluminum exposure in dialysis patientsappears to be fairly effective in preventingaluminum loading and skeletal toxicity,manifested as a mineralization defect.How-ever,aluminum restriction had no influenceon high turnover bone disease or the ady-namic type of low turnover disease support-ing a different etiology for these two typesof bone disease. Aluminum intoxication has been a ma-jor cause of morbidity and mortality in dia-lyzed uremic patients. During the last 7-years means to markedly reduce aluminumexposure in this population have been im-plemented.This study was carried out to de-termine how effective restriction of alu-minum exposure has been in preventing alu-minum loading and toxicity in uremic pa-tients. Methods All bone histology processed onpatients with end-stage renal disease (452 ​​patients) between January 1984 and Decem-ber 1991 were reviewed. Histomorphometric studies were performed and bones dividedinto four major grouping: ①high turnover, osteitis firosa; ②low turnover, osteomala-cia; ③low turnover, adynamic and ④mixedtype bone disease. Results between 1985 and 1991 a signifi-cant decrease in aluminum loading wasfound in patients with end- stage renal dis-ease as determined by a fall in plasma alu-minum from 74 ± 30 μg / L to 12 ± 7 μg / L and decrease in aluminum positive bonespecimens from 87.2% to 35.8% (P <0.01) .With t he reduction in aluminumloading low turnover osteomalacic bone dis-ease decreased from 11.6% to less than 5% (P <0.05) of the total bone specimens derived and the fraction of mixed bone dis-ease with osteomalacic features decreasedfrom 33% to 19% (P <0.03). There was nochange in the other types of bone disease. Conclusions The present methods of limit-ing aluminum exposure in dialysis patientsappears to be fairly effective in preventinguminum loading and skeletal toxicity, manifested as a mineralization defect .How-ever, aluminum restriction had no influenceon high turnover bone disease or the ady-namic type of low turnover disease support-ing a different etiology for these two types of bone disease.