Abstract: Objective To investigate the characteristics of renal bone disease especially the high turnover bone disease and to evaluate the significance of various clinical biomarkers for renal bone disease by histological observation of bone biopsies from chronic kidney disease (CKD) patients at stage 5 and on maintenance hemodialysis. Methods Bone biopsy was performed in 40 CKD patients at stage 5 as well as 3 normal persons. Bone biopsies were studied by histomorphometric measurement using an automatic image analysis system. Serum level of biomarkers and bone pathological parameters were studied by correlation analysis. Results Twenty-five of the 40 uremic patients (62.5%) were found to have high turnover bone disease based on bone histological changes. High turnover bone disease was characterized by the hyperactivity of osteoclasts with or without bone mineral deposit impairment. There was a close relationship between serum levels of calcium and osteocalcin and histomorphometric parameters. Conclusions High turnover bone disease is the major type of bone disease in CKD patients at stage 5. Serum levels of calcium and osteocalcin may be predictive for high turnover bone disease in clinical practice. Bone biopsy is still the essential approach for the diagnosis.

Key words: Hemodialysis, Bone biopsy, High turnover renal bone disease, Serum calcium, Serum osteocalcin, Bone mineral density, Bone X-ray