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1 Aluminium concentrations were measured in hair, plasma and bone samples from different groups of chronic renal insufficient patients and from a control group (75 healthy volunteers plus 21 deceased subjects). A cross-sectional study with 40 haemodialysis patients and two longitudinal studies were undertaken, the first comprising of 12 home haemodialysis patients and the second 16 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). 2 Before introduction of water treatment by reverse osmosis, the hair aluminium levels of home haemodialysis patients were elevated compared to controls. Aluminium in the hair of all other groups were within the normal range. Hair aluminium levels were not related to the daily aluminium intake, nor to the cumulative aluminium intake, nor to bone and plasma aluminium concentrations. 3 Plasma aluminium concentrations in all patients were higher than in the controls. Dialysis without reverse osmosis water treatment increased aluminium plasma levels. After installation of reverse osmosis units there was a decrease in the aluminium concentrations in plasma. In CAPD patients insignificant increases in the aluminium levels in plasma were observed. When low contaminated dialysis fluid was available the plasma aluminium concentrations returned to the initial level. 4 Aluminium concentrations in bone were increased in renal insufficient patients compared with controls. Aluminium bone content increased with increasing cumulative aluminium intake by phosphate binding therapy. 5 Hair analysis is of very limited value for the diagnosis of aluminium exposure. Bone analysis is suitable for the assessment of the individual body burden.

Aluminum concentrations in the dialysate and serum of 14 patients on CAPD were measured every six months. Additionally, in ten of the patients Al elimination was measured after a bolus ingestion of 1800 mg aluminium-chloride-hydroxide-complex. There was no significant difference between serum Al concentrations initially (47.3 +/- 8.2 micrograms/l), at six months (55.4 +/- 9.5 micrograms/l), and after 12 months (44.3 +/- 10.1 micrograms/l) although the Al concentration in the dialysate had been decreased from 16.6 +/- 2.3 micrograms/l to 1.5 +/- 0.2 in the last six months. The Al concentrations in the effluent dialysate were 14.5 +/- 1.3 micrograms/l initially, 15.6 +/- 1.2 micrograms/l after six months and 11.9 +/- 2.6 micrograms/l after 12 months. During kinetic studies a constant rise of serum Al concentration was found until the fifth hour, from 29.9 +/- 2.5 to 42.5 +/- 4.0, and a decline after 24 hours to 32.4 +/- 3.0 micrograms/l. The quantity of Al eliminated was 41.1 +/- 8.7 micrograms/24 h, equivalent to 1.2% of the ingested dose. In patients with residual renal function, renal Al clearance was almost double the peritoneal one. These results indicate that Al elimination by CAPD is not efficient and ingestion of Al-containing phosphate binders can result in Al accumulation.

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Intestinal absorption of aluminum (Al) from the phosphate binder aluminum-hydroxide-chloride (PhosphonormR) and successive renal and peritoneal Al elimination were studied in 11 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Al was measured by atomic absorption spectrometry in serum, urine, and dialysis fluid. Al levels in serum of all patients increased in average from 28.6 micrograms/l immediately before to a peak level of 41.6 microgramsWl 4 h after intake of 342 mg Al. After 24 h serum Al (34.0 micrograms/l) was still increased. Elimination across the peritoneum increased from 5.6 micrograms Al during the first 4 h to peak levels of 12.9 micrograms between hour 8 and 12 and decreased to 8.1 micrograms during the last 12 h. The Al clearance of the peritoneum was 0.43 ml/min. In the 6 patients with residual diuresis the renal Al excretion was higher than the peritoneal removal (48.1 micrograms/24 h vs. 24.8 micrograms/24 h). The renal Al clearance amounted to 1.6 ml/min. Assuming a gastrointestinal absorption quotient of 0.1% it is concluded that Al removal by CAPD in patients receiving 342 mg Al/day is not sufficient to prevent Al accumulation. In patients with remaining diuresis, the renal Al elimination exceeds the Al removal by the peritoneum.