Elimination von Aluminium bei kontinuierlicher ambulanter Peritonealdialyse

Abstract

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.

Risk Factors and Consequences of Hyperaluminemia in a Peritoneal Dialysis Cohort

“…Aside from a lower reticulocyte count (which was present before PD initiation, and therefore before Al exposure), none of the foregoing signs or symptoms were observed in the exposed group at the moment of solution change. Despite the extensive tissue distribution and half-life of Al (14), we suspect that Al exposure in our patients was not severe or prolonged enough to lead to significant clinical sequelae. Had the problem gone unnoticed, patients would undoubtedly have continued to accumulate Al with serious clinical effects.…”

“…Significant residual renal function is known to be protective against Al accumulation, permitting removal of approximately 2 μmol daily in chronic kidney disease patients (3,11-15). Furthermore, the relationship was found to be logarithmic: that is, small increments in renal function (above 0.1 mL/min) had a major effect on serum Al.…”