Mactier R A
Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland.
Adv Perit Dial. 1991;7:26-9.
Reduced renal clearance of aluminum and regular intake of aluminum containing phosphate binders render dialysis patients at increased risk of aluminum accumulation and toxicity. Provided the inflow dialysate aluminum concentration is kept low (less than 10 micrograms/L) most CAPD patients have negative peritoneal mass transfer of aluminum in the effluent dialysate. Net removal of aluminum in the dialysate partially compensates for the loss of renal clearance of aluminum and helps prevent progressive tissue accumulation of aluminum. Rates of aluminum removal in the dialysate are too low, however, for effective treatment of patients with established aluminum accumulation or overt aluminum toxicity. Such patients usually require parenteral deferoxamine therapy to achieve increased aluminum removal rates. The optimum route, dosage and frequency of administration of deferoxamine in CAPD patients are not established. From the existing data, 2 g deferoxamine administration intraperitoneally three times per week in the overnight exchange appears to provide the maximum aluminum removal for minimum deferoxamine dosage.
铝的肾脏清除率降低以及长期摄入含铝的磷结合剂使透析患者铝蓄积和中毒的风险增加。如果流入的透析液铝浓度保持在低水平（低于10微克/升），大多数持续性非卧床腹膜透析（CAPD）患者的流出透析液中铝的腹膜质量转移为负。透析液中铝的净清除部分补偿了铝肾脏清除率的损失，并有助于防止铝在组织中进行性蓄积。然而，透析液中铝的清除率过低，无法有效治疗已发生铝蓄积或明显铝中毒的患者。此类患者通常需要胃肠外去铁胺治疗以提高铝的清除率。CAPD患者中去铁胺的最佳给药途径、剂量和频率尚未确定。根据现有数据，每周三次在夜间交换时腹腔内给予2克去铁胺似乎能以最低的去铁胺剂量实现最大的铝清除。
