Value of serum aluminium monitoring in dialysis patients: a multicentre study.
The clinical relevance of regular serum aluminium monitoring in dialysis patients was investigated in a multicentre study by 6-monthly determination of the serum aluminium during 4 consecutive years. In a group totalling 1193 patients, a striking decrease of mean serum aluminium was observed the last 2 years of the study. This phenomenon was accompanied by a substantial reduction of the prescribed dose of aluminium hydroxide (Al(OH)3) and its partial replacement by calcium carbonate (CaCO3) and/or magnesium hydroxide (Mg(OH)2). Under this policy serum phosphate control remained satisfactory. In all the centres, water treatment was found to be adequate, yielding dialysate aluminium around 2 micrograms/l. Dialysis patients with clinically overt liver disease showed a significantly greater median serum aluminium concentration than that observed in a control dialysis population. Compared to the latter group, the median serum aluminium concentration of dialysis patients with diabetes mellitus did not differ significantly. Results further indicated that patients with biopsy-proven osteomalacia presented a significantly greater median serum aluminium compared to that of patients without osteomalacia. We demonstrated that a serum aluminium of 60 micrograms/l provides a relatively sensitive (82%) and specific (86%) index for the detection of aluminium-related bone disease (ARBD). Provided the aluminium determinations are performed by a qualified laboratory, serum monitoring in dialysis patients (a) allows the safer use of aluminium-containing phosphate binders, and (b) is of value in the diagnosis of overload/toxicity.
D'Haese
P C
PC
University of Antwerp, Department of Nephrology-Hypertension, Belgium.
Clement
J P
JP
Elseviers
M M
MM
Lamberts
L V
LV
Van de Vyver
F L
FL
Visser
W J
WJ
De Broe
M E
ME
D000328:Adult; D000368:Aged; D000375:Aging / Q000378:metabolism; D000535:Aluminum / Q000032:analysis / Q000097:blood*; D000536:Aluminum Hydroxide / Q000008:administration & dosage; D001847:Bone Diseases / Q000378:metabolism / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications; D008107:Liver Diseases / Q000150:complications; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015337:Multicenter Studies as Topic; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors
D000536:Aluminum Hydroxide; D000535:Aluminum