Effect of aluminum mobilization on hemoglobin during the first six months after transplantation

Abstract

We prospectively monitored 38 patients for the first six months following successful renal cadaver allograft transplantation. Hemoglobin increased from a mean of 8.2 +/- 0.3 g/dl to 13.4 +/- 0.3 g/dl (SEM), P < 0.001, plasma aluminum decreased from 1.3 +/- 0.2 mumol/liter to 0.46 +/- 0.04 mumol/liter, P < 0.001, and urinary aluminum excretion which peaked at one week post-transplant, 5.5 +/- 1.3 mumol/24 hr decreased to 1.8 +/- 0.3 mumol/24 hr, P < 0.001. Prior to transplantation 22 patients had been prescribed aluminum-containing phosphate binders. Following transplantation this group had persistently greater plasma aluminum and urinary aluminum concentrations which were sustained throughout the study period, compared with those not given aluminum containing medicaments. Hemoglobin and iron status were similar in the two groups prior to transplantation, although red blood cell volume was smaller in those given aluminum-containing phosphate binders, 89 +/- 0.9 fl (fentoliters) versus 95 +/- 1.6 fl, P < 0.05. However, the percentage increase in hemoglobin following transplantation was greater in the group not given aluminum preparations, 34 +/- 4% versus 7 +/- 5% at one month, 69 +/- 7% versus 37 +/- 7% at three months, and 80 +/- 8% versus 56 +/- 8% at six months respectively, all P < 0.05. This study suggests that aluminum mobilization following successful renal transplantation may reduce the rate of hemopoiesis.

Cross‐sectional audit of blood lead levels in regular outpatient haemodialysis patients dialysing in north London

“…Whereas there are reports of both aluminium and lead being deposited in bone in haemodialysis patients, and aluminium may affect erythropoesis, 16 there was no correlation between the blood lead and haematocrit, or erythropoietin requirements and/or ferritin, confirming earlier reports 17 . Although relatively low blood lead levels depress 5‐amino laevulinic acid synthase activity, very high levels are required before patients develop anaemia 2…”

Trace Elements in Patients with Chronic Kidney Disease

“…65,66 Aluminum can compete for key enzymes involved in the synthesis of hemoglobin (delta-aminolavelunic acid dehydratase and heme synthase), resulting in the development of anemia. 67,68 In severe cases of aluminum toxicity, patients can present with memory loss, a pseudo-Parkinsonian gait, tremor, which may progress to seizures, dementia, and death. 69 Aluminum is taken up into macrophages and leukocytes and may affect immune function in CKD patients.…”

Systemic Cardiovascular Response in Hemodialysis without and with Ultrafiltration with Membranes of High and Low Biocompatibility

“…A previous study has reported a similar lack of influence by membrane bioincompatibility on systemic hemodynamics during isolated hemodialysis with acetate buffer [7], and oth er investigators have also reported that the change in arterial blood pressure during bicar 237 bonate hemodialysis was not related to mem brane biocompatibility [15]. However, a re cent study of hemodynamics during hemofil tration in patients with combined renal and hepatic failure showed that membranes of low biocompatibility were associated with a more pronounced depression of cardiac output and perfusion pressure [13]. Thus, although our results and those of others indicate that the biocompatibility of the dialyzer membrane does not significantly influence systemic he modynamics during hemodialysis in hemodynamically stable patients, further investiga tions are needed to evaluate the implications in unstable patients.…”

“…10]. Whether membrane biocompatibility also influences hemodynamics during hemo dialysis has not been settled [1][2][3][11][12], Previous studies indicate that membranes with low biocompatibilitv are associated with elevated pulmonary vascular resistance [7] and may induce hemodynamic instability in critically ill patients [13] whereas stable he modialysis patients seem to be less influenced [7,14,15]. However, the hemodynamic in fluence of bioincompatibility during hemodi alysis may be confounded by the concomitant circulatory responses to volume depletion (i.e.…”