Rapid removal of DFO-chelated aluminum during hemodialysis using polysulfone dialyzers

Abstract

Aluminum (Al) removal following deferoxamine (DFO) therapy in hemodialysis patients was evaluated in a paired-fashion comparing cuprophane (Travenol 12.11) and polysulfone (Fresenius F-80) dialyzers. QB and QD were held constant at 250 and 500 ml/min, respectively. The polysulfone dialyzer increased total plasma Al clearance from 20.0 +/- 2.8 to 80.5 +/- 7.6 ml/min (P less than 0.01), and reduced the t 1/2 of plasma Al during hemodialysis from 538 +/- 113 to 112 +/- 12 min (P less than 0.01). The polysulfone F-80 dialyzer increased Al removal during the first hour of hemodialysis from 518 +/- 191 to 1812 +/- 720 micrograms/hr (P less than 0.01). During a four hour hemodialysis the F-80 dialyzer returned plasma Al levels to pre-DFO values (103 +/- 36 vs. 93 +/- 23, P less than 0.05), suggesting complete removal of the DFO chelated Al complex. In one patient Al removal was evaluated using cuprophane, F-40, F-60 and F-80 dialyzers and the t 1/2 for Al removed decreased from 484.6 to 276.1 and 108 to 99 minutes, respectively. These data show the Fresenius F-80 polysulfone dialyzer effects the rapid removal of DFO-Al complexes. We propose use of the Fresenius F-80 dialyzer in conjunction with reduced DFO doses and i.m. administration of DFO the day prior to dialysis to limit DFO exposure as a method to decrease DFO-related side-effects in hemodialysis patients.

Adynamic bone disease--bone and beyond

“…Long-term application of DFO (11 ± 4 months, dosage 42 ± 17 mg/kg administered once weekly) also improved signs of dementia and increased erythrocyte mean corpuscular volume, but side effects were common [ 95 ]. Polysulfone dialyzers offer maximum clearance of DFO-aluminium complexes [ 96 ]. Parathyroidectomy should be avoided in patients with aluminium-induced bone disease, since the decrease in bone turnover after surgery may be associated with an accelerated accumulation of aluminium in bone [ 97 ].…”

Association of Serum Aluminum Levels with Mortality in Patients on Chronic Hemodialysis

“…The first step in the prevention of aluminum toxicity is minimizing exposure to these medications, particularly aluminum-containing phosphate binders. Moreover, intensive hemodialysis (six times per week for 4–6 weeks) with a high-flux artificial kidney can efficiently remove aluminum 12 , 40 . Finally, the efficacy of early deferoxamine therapy still requires further evaluations to ascertain its benefits and risks.…”

Intoxicação alumínica na DRC

“…Entre os tipos de membrana que contribuem para maior remoção do Al, destacam-se as de polissulfona e poliacrilonitrilo. 29 A membrana peritoneal também é capaz de remover adequadamente o Al. 30 A hemoperfusão ou hemofiltração, por se tratar de procedimento dispendioso, são atualmente reservadas àqueles casos de intoxicação grave com manifestação clínica de neurotoxicidade.…”