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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
In a recent bone biopsy-based study from Egypt by the authors, a high prevalence of aluminum bone disease was found. Accordingly, we revised the latest bone biopsy-based studies in the last 25 years to determine if that is a local problem or an international challenge. Historically, Osteomalacia (vitamin D deficiency or aluminum-induced) was a common finding till the development of reverse osmosis and vitamin D analogues. This led to “a presumed” extinction of aluminum bone disease.
A literature review was conducted using PubMed and Scopus to identify studies that involved bone biopsy reporting the prevalence of different renal osteodystrophy (ROD) types, even as a secondary endpoint. Then, the possible sources of aluminum were investigated in the root cause analysis in Figure 1.
Regarding the ROD pattern prevalence, some studies reported only the turnover to correlate with turnover biomarkers, others reported the specific ROD pattern; the latter was reported in pie charts in Figure 2 below each corresponding study. Aluminum bone disease was nearly disappearing, except in the Brazilian registry in 2023 and our recent Egyptian cohort, despite minimal or even no aluminum-based phosphate binders’ usage. Interestingly, the cohort from Thailand in 2019 had no cases of aluminum bone toxicity found, although > 40% of their patients were using aluminum-containing phosphate binders.
In our Egyptian cohort, municipal tap water drinking was more common in the AL+ve (significant aluminum toxicity) group in comparison to home water filter users. Random samples from their dialysate and drinking water were rechecked at central labs in the USA, and all were within standard limits. Aluminum concentrations in them were 0.064 ppm in municipal tap water and <0.001 ppm dialysate water. So, direct water toxicity was not confirmed.
When analyzing biopsied patients with low turnover states and checking their drinking water sources, 7 patients used municipal tap water and 4 used home water filters. Results were not significant due to the limited number of patients, but the difference is visualy evident, as shown in Figure 3. Considering the systematic use of aluminum sulfate in municipal water purification, intermittent aluminum leakage to tap water that is not captured in our screening cannot be excluded.
More bone biopsy studies in developing countries are needed, as the ROD spectrum is not universal. Aluminum bone disease is not a rare finding in Brazil and Egypt, with a prevalence of 38% and 57% of the biopsied patients, respectively. It has to be in differential diagnosis, especially in developing countries, even if they are not receiving aluminum-based phosphate binders. Extinsive environmental surveilenc is needed in those countries.
