Aluminum and deferoxamine kinetics in CAPD.

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.