Risk of orally administered aluminium hydroxide and results of withdrawal

In 23 haemodialysis patients, taking regularly aluminium hydroxide (Al(OH)3) of various dosage regimens for more than 18 months, three developed aluminium (Al) related morbidity (fracturing osteopathy 3/3, encephalopathy 2/3, 1/3 died). In 15 patients followed for 14 months after Al(OH)3 withdrawal the previously elevated serum Al concentrations fell and no worsening of osteodystrophy (especially hyperparathyroidism) could be demonstrated. Our data and other reports suggest that oral administration of Al containing phosphate binders causes unacceptable morbidity for an unproven benefit, and should be avoided.