Dialysis encephalopathy: precipitating factors and improvement in prognosis.

The course of typical dialysis encephalopathy (D.E.) in 12 patients is described. Five patients are still alive from 31 to 57 months after the onset of the disease. Their mental state has improved, but 3 have severe, residual paraplegia. Improvement was associated with the presence of a well functioning renal transplant or dialysis with deionized water. Only one case has developed since deionization of water containing more than 50/micrograms/l of aluminium has been routine. The patients' histories suggest that immobilization, surgery, administration of corticosteroids and hypophosphatemia, all of which induce a negative calcium balance, may release aluminium or another toxic substance from bone and precipitate the onset of D.E.