Deferoxamine and aluminum clearance in pediatric hemodialysis patients

Mobilization of aluminum by deferoxamine and the subsequent clearance from plasma by hemodialysis with or without charcoal hemofiltration was studied in four pediatric patients. Deferoxamine, 10-20 mg/kg, followed by dialysis with a Travenol CA50 dialyzer produced reductions in mean plasma aluminum levels from 2433 +/- 729 nmol/l (65.5 +/- 19.6 micrograms/l) to 1727 +/- 554 nmol/l (46.5 +/- 14.9 micrograms/l) during dialysis. The use of a charcoal cartridge in the circuit resulted in a reduction in mean plasma aluminum levels 2459 +/- 591 nmol/l (66.2 +/- 15.9 micrograms/ml) to 1380 +/- 106 nmol/l (35.8 +/- 2.9 micrograms/l). In one patient, high-flux dialysis produced a reduction from 2140 nmol/l (55.6 micrograms/l) to 1134 nmol/l (29.4 micrograms/l). No patients suffered direct adverse reactions to low-dose deferoxamine, although two patients had previously exhibited potential aluminum neurotoxicity after rapid increases in plasma aluminum levels with deferoxamine in higher doses. Aluminum levels must be monitored closely during deferoxamine therapy in uremic children to minimize the risk of exacerbating aluminum neurotoxicity.