Aluminum loading in children with chronic renal failure

Area of Science:

• Pediatric Nephrology
• Clinical Toxicology
• Biochemistry

Background:

• Chronic renal failure in children often requires management of hyperphosphatemia.
• Aluminum-containing antacids are frequently used to control hyperphosphatemia in these patients.
• Potential for aluminum accumulation and toxicity exists with long-term use.

Purpose of the Study:

• To investigate plasma and bone aluminum levels in children with chronic renal failure.
• To assess the correlation between oral aluminum dosage and plasma aluminum concentrations.
• To identify risk factors and clinical signs of aluminum toxicity in this pediatric population.

Main Methods:

• Plasma aluminum levels were measured in 17 children with chronic renal failure.
• Bone aluminum levels were assessed in a subset of patients.
• Oral aluminum dosage and dialysis status were recorded.
• Aluminum levels in dialysate and tap water were analyzed.

Main Results:

• Plasma aluminum levels directly correlated with oral aluminum dosage.
• Extremely high levels were found in small, non-dialyzed children.
• Bone aluminum confirmed significant aluminum loading in four patients.
• Aluminum toxicity signs were present in patients with plasma levels > 100 µg/L and oral intake > 75 mg/kg/day.

Conclusions:

• Children requiring > 30 mg/kg/day of elemental aluminum for hyperphosphatemia control need plasma aluminum monitoring.
• Consider alternative therapies like dietary restrictions or intensified dialysis to prevent aluminum toxicity.
• Early detection and intervention are vital for managing aluminum loading in pediatric chronic renal failure.