title: Aluminum removal with hemodialysis, hemofiltration and charcoal hemoperfusion in uremic patients after desferrioxamine infusion. A comparison of efficiency.
abstract: In order to compare the effectiveness of aluminum removal in uremic patients during extracorporeal treatment, 17 patients with endstage renal failure were given a desferrioxamine infusion of 40 mg/kg body weight after an ordinary dialysis treatment. Forty-eight hours later 7 patients were treated with hemodialysis, 6 with hemofiltration and 4 with a combination of hemodialysis and hemoperfusion. The clearance of aluminum was measured at different intervals. It was found that the aluminum clearance was 75 +/- 18 ml/min in hemofiltration compared to 30 +/- 10 ml/min in hemodialysis (p less than 0.001). A combination of hemodialysis and hemoperfusion with a charcoal column containing 100 g activated charcoal in series gave a total aluminum clearance of 56 +/- 11 ml/min. The total amount of aluminum in the ultrafiltrate after hemofiltration was found to be approximately 3 times as high (1,728 +/- 156 micrograms) as the total amount of aluminum in the hemodialysis water that had passed a single pass system during a 4-hour dialysis (576 +/- 104 micrograms). Our results indicate that hemofiltration or a combination of hemodialysis and hemoperfusion should be used to remove aluminum in patients with signs of severe aluminum accumulation such as encephalopathy or painful bone disease, because these methods are 2-3 times as effective as ordinary hemodialysis. In patients where aluminum has been accumulated but no severe symptoms occur hemodialysis gives a significant clearance of the aluminum desferrioxamine complex.
authors.affiliation: Department of Internal Medicine, University Hospital, Uppsala, Sweden.
authors.forename: L G
authors.initials: LG
authors.lastname: Weiss
authors.forename: B G
authors.initials: BG
authors.lastname: Danielson
authors.forename: B
authors.initials: B
authors.lastname: Fellström
authors.forename: B
authors.initials: B
authors.lastname: Wikström
mesh_terms: D000535:Aluminum / Q000032:analysis* / Q000378:metabolism; D002606:Charcoal; D003676:Deferoxamine / Q000008:administration & dosage* / Q000627:therapeutic use; D015312:Hemodialysis Solutions / Q000032:analysis; D006440:Hemofiltration; D006464:Hemoperfusion; D006801:Humans; D007263:Infusions, Parenteral; D006435:Renal Dialysis; D012996:Solutions; D014511:Uremia / Q000378:metabolism / Q000628:therapy*
chemical_list: D015312:Hemodialysis Solutions; D012996:Solutions; D002606:Charcoal; D000535:Aluminum; D003676:Deferoxamine