Assessing the utility of testing aluminum levels in dialysis patients

作者：Sharma Ashish K^*; Toussaint Nigel D; Pickering Janice; Beeston Tony; Smith Edward R; Holt Stephen G

来源：Hemodialysis International, 2015, 19(2): 256-262.

DOI：10.1111/hdi.12231

• Aluminum
• chronic kidney disease
• contamination
• dialysis
• hemodialysis
• phosphate binders

Plasma aluminum (Al) is routinely tested in many dialysis patients. Aluminum exposure may lead to acute toxicity and levels in excess of approximate to 2.2mol/L (60g/L) should be avoided. Historically, toxicity has been caused by excessive dialyzate Al but modern reverse osmosis (RO) water should be Al free. Nevertheless, many units continue to perform routine Al levels on dialysis patients. This single-center study retrospectively analyzed Al levels in plasma, raw water feed, and RO product between 2010 and 2013 using our database (Nephworks 6) with the aim of determining the utility of these measurements. Two thousand fifty-eight plasma Al tests in 755 patients (61.9% male, mean age 64.7 years) were reviewed showing mean +/- SD of 0.41 +/- 0.30mol/L. One hundred eleven (5.4%) tests from 61 patients had Al levels >0.74mol/L and 45 (73.8%) of these patients were or had been prescribed Al hydroxide (Al(OH)(3)) as a phosphate binder. Seven patients had Al concentrations >2.2mol/L with no source of Al identified in 1 patient. One hundred sixty-six patients taking Al(OH)(3) (78.7% of all patients on Al(OH)(3)) had levels 0.74mol/L, the odds ratio of plasma Al>0.74mol/L on Al(OH)(3) was 9. The cost of plasma Al assay is $A30.60; thus, costs were $A62,974.80 over the study period. Despite RO feed water Al levels as high as 48mol/L, Al output from the RO was almost always undetectable (<0.1mol/L) with dialyzate Al levels>2.2mol/L only 3 times since 2010, and never in the last 3 years. Routine unselected testing of plasma Al appears unnecessary and expensive and more selective testing in dialysis patients should be considered.

• 出版日期2015-4