Intestinal absorption of aluminium in renal failure

The proportion of the daily ingested aluminium that is absorbed in the intestinal tract has remained a matter of debate for many years because no reliable method of measurement was available. Studies with earlier analytic techniques reported fractional absorption of aluminium from as little as 0.001% to as much as 27% of an oral dose. Measurement of (26)Al by high-energy accelerator mass spectrometry has permitted more accurate analyses. In normal young rats, 0.05-0.1% of ingested aluminium is absorbed in the intestine, of which roughly half goes to the skeleton within 2 h, whereas the remaining half is excreted in the urine, most of it within 48 h. Deposition in organs other than the skeleton appears to be negligible. In healthy human volunteers, the most recent estimates of fractional intestinal (26)Al absorption were also in the range of 0.06-0.1%. In both rats and humans, intestinal absorption of aluminium is subject to many systemic and local factors. The latter include various compounds with which aluminium is complexed in the gut lumen, and gastric acidity. The influence of food is controversial; however, absorption appears higher in the fasted than the post-prandial state. Luminal phosphate concentration decreases aluminium absorption, whereas citrate increases it. For theoretical reasons, silicates should prevent aluminium absorption, but experimental evidence has not supported this theory. Whether water hardness affects aluminium bioavailability remains a matter of debate. General conditions may also modify aluminium absorption and deposition in bone. Examples of these general factors include the uraemic syndrome, diabetes mellitus, secondary hyperparathyroidism, vitamin D status, Alzheimer's disease and Down's syndrome. Awareness of intestinal absorption of aluminium is particularly important, given that aluminium-based binders continue to be used in uraemic patients, despite the hazards of aluminium accumulation. The lessons we have learned about aluminium absorption-from the methodological difficulties of measuring it accurately to understanding the long-term clinical risks of this metal-should guide us in the safety evaluation of other potentially toxic metals that have been proposed for therapeutic use in patients with renal failure.