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Can low-dosage aluminium hydroxide control the plasma phosphate without bone toxicity?
D A Jenkins1, D Gouldesbrough, G D Smith
1University Department of Medicine, Royal Infirmary, Edinburgh.
Summary
Low-dose aluminium hydroxide phosphate binders effectively controlled plasma phosphate in haemodialysis patients for up to 7 years. This study found no significant bone aluminium toxicity, suggesting a safe medium-term treatment option.
Area of Science:
- Nephrology
- Bone Metabolism
- Toxicology
Background:
- Aluminium accumulation from phosphate binders is a concern in haemodialysis patients.
- Long-term effects of aluminium exposure on bone health require further investigation.
Purpose of the Study:
- To assess bone aluminium accumulation and toxicity in patients undergoing long-term haemodialysis.
- To evaluate the efficacy of low-dose aluminium hydroxide in managing hyperphosphatemia.
Main Methods:
- Assessed 16 haemodialysis patients treated with reverse osmosis water and restricted aluminium hydroxide doses (max 2.85 g/day).
- Evaluated bone aluminium staining, histological evidence of osteomalacia, and plasma phosphate levels over time.
Main Results:
- Adequate plasma phosphate control was achieved in most patients (13/16).
- Bone aluminium staining was minimal (2/16 patients), with no significant association with osteomalacia.
- Mean bone aluminium levels were moderately high but did not exceed 40 micrograms/g in most patients.
Conclusions:
- Low-dose aluminium hydroxide can effectively manage hyperphosphatemia in haemodialysis patients.
- Medium-term use of aluminium hydroxide at restricted doses is not associated with significant bone aluminium toxicity.