Assessing the benefit of changing aluminium hydroxide schedule on anaemia and serum phosphorus control

Convincing evidence exists concerning aluminium hydroxide (A1 (OH)3) absorption and risk of toxicity. Over recent years our aim has been to reduce exposure to this risk. In this study we evaluated the effect of changing our A1 (OH)3 prescription policy, reducing its intake by stopping the breakfast dose, separating the iron intake from the binder's influence, and tailoring the A1 (OH)3 dose according to the protein intake patterns. The change was done gradually, initially in a pilot group and then in the whole unit. The results from the pilot group, who completed two years follow-up and from the whole unit, when more patients adhered to the new scheme, were similar. After the A1 (OH)3 reduction serum phosphorus did not change, haemoglobin increased and the blood transfusion requirements decreased. These results support our preliminary findings that A1 (OH)3 might interfere with erythropoiesis and stress the necessity of reassessing the prescription of binders thoroughly aiming to give adequate individual doses according to the different protein intake patterns.