[Detecting and evaluating hyperaluminemia in 3 dialysis centers]

Area of Science:

• Clinical Chemistry
• Toxicology
• Nephrology

Context:

• Patients undergoing dialysis are at risk of aluminium exposure through dialysate solutions.
• Chronic aluminium exposure can lead to toxic accumulation in tissues.
• Osteomalacia is a known complication of aluminium toxicity.

Purpose:

• To investigate plasma aluminium levels in patients with varying dialysate aluminium content.
• To assess the impact of desferrioxamine administration on plasma and tissue aluminium levels.
• To determine the clinical relevance of specific plasma aluminium concentrations.

Summary:

• In 101 patients, prolonged exposure to dialysate with >20 µg/L aluminium resulted in average plasma aluminium of 80 µg/L, rising to 211 µg/L after desferrioxamine administration.
• Sixteen patients with biopsy-proven osteomalacia showed plasma aluminium levels ranging from 80-250 µg/L.
• Oral aluminium intake and long-term desferrioxamine treatment can lead to significant aluminium accumulation, detectable even with initially low plasma levels.

Impact:

• Plasma aluminium levels between 40-80 µg/L may indicate clinical relevance and potential toxicity.
• The desferrioxamine test is crucial for identifying hidden aluminium burden in patients.
• Findings highlight the importance of monitoring aluminium levels in dialysis patients and considering alternative treatments to prevent toxicity.