title: Aluminium-containing agents may be toxic in predialysis chronic renal insufficiency patients.
abstract: OBJECTIVE
  To investigate the possible toxic effects of long-term low dose aluminium (Al) exposure in predialysis chronic renal insufficiency (CRI) patients (serum creatinine > 1.4 mg dL-1).
  
  
  METHODS
  An open, random, and prospective clinical study.
  
  
  METHODS
  The study was carried out at Chang Gung Memorial Hospital, a medical centre of Chang Gung Medical College.
  
  
  METHODS
  Seventy CRI patients who have regularly attended a nephrology out-patient department participated in this study. After a 3-month wash-out period 50 were given an Al loading test and 20 received no Al-containing agents.
  
  
  METHODS
  We used a low dose of Al(OH)3 (one tablet three times day-1, about 302 mg aluminium day-1) for 3 months as an Al loading test.
  
  
  METHODS
  The study was divided into two phases: phase 1. a basal study to measure serum Al, iron, ferritin, daily urinary Al excretion and renal function status; and phase 2, in which an Al loading test was performed. The phase 1 parameters were measured again after the Al loading test to compare the differences between pre- and post-study in the two groups.
  
  
  RESULTS
  We found significant increments of serum Al and daily urinary Al excretion in all study group patients after the Al loading test. The increments of serum Al correlated with basal creatinine clearance (Ccr: r = -0.352, P < 0.05) and basal serum ferritin (r = -0.302, P < 0.05). Serum ferritin was significantly reduced after the Al loading tests, and the reduction (r = 0.357, P < 0.05) positively correlated with the increments of daily urinary Al excretion in the study group patients. However, no significant changes of serum Al, ferritin, and daily urinary Al excretion were noted in the control group patients.
  
  
  CONCLUSIONS
  A long-term low dose Al exposure can cause significant Al accumulation and iron store depletion in CRI patients. Therefore, Al-containing agents should be used with caution in patients with CRI.
authors.affiliation: Division of Nephrology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung Medical College, Taipei, Taiwan.
authors.forename: J L
authors.initials: JL
authors.lastname: Lin
authors.forename: M L
authors.initials: ML
authors.lastname: Leu
mesh_terms: D000328:Adult; D000368:Aged; D000535:Aluminum / Q000097:blood / Q000493:pharmacokinetics* / Q000652:urine; D017607:Aluminum Compounds / Q000009:adverse effects*; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000097:blood; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D017607:Aluminum Compounds; D005293:Ferritins; D000535:Aluminum; D007501:Iron