Aluminum load in chronic intermittent plasma exchange

Area of Science:

• Biochemistry
• Clinical Chemistry
• Nephrology

Background:

• Aluminum (Al) exposure is a concern in patients receiving medical treatments.
• Human albumin (HA) solutions are used in various therapeutic settings, including plasma exchange.
• The aluminum content in HA preparations can vary significantly by manufacturer.

Purpose of the Study:

• To investigate aluminum loading in patients undergoing plasma exchange due to varying aluminum content in human albumin solutions.
• To quantify aluminum uptake and excretion in relation to human albumin contamination levels.
• To assess the long-term impact of aluminum accumulation on bone tissue.

Main Methods:

• Two patients with hyperviscosity syndrome underwent plasma exchange (once or twice weekly).
• Aluminum levels were measured using Zeeman-AAS in plasma, bone, and various human albumin preparations.
• Net aluminum uptake and 24-hour urinary excretion were determined between treatments.

Main Results:

• Plasma aluminum levels increased significantly with higher aluminum content in human albumin solutions.
• Average net aluminum uptake was substantially higher with highly contaminated HA (1419 µg/L) compared to medium (574 µg/L) or low (47 µg/L) contamination.
• One patient showed a negative weekly aluminum balance and no bone aluminum increase after 10 months when using low-aluminum HA.

Conclusions:

• The aluminum content of human albumin solutions directly impacts patient aluminum loading during plasma exchange.
• Using human albumin with low aluminum contamination is crucial for patients undergoing chronic intermittent plasma exchange.
• Minimizing aluminum exposure is particularly important for patients with impaired renal function.