Department of Renal Medicine and Transplantation, Royal London and St Bartholomew's Hospitals, London, UK.
BMC Nephrol. 2011 Oct 12;12:55. doi: 10.1186/1471-2369-12-55.
Aluminium (Al) toxicity was frequent in the 1980s in patients ingesting Al containing phosphate binders (Alucaps) whilst having HD using water potentially contaminated with Al. The aim of this study was to determine the risk of Al toxicity in HD patients receiving Alucaps but never exposed to contaminated dialysate water.
HD patients only treated with Reverse Osmosis(RO) treated dialysis water with either current or past exposure to Alucaps were given standardised DFO tests. Post-DFO serum Al level > 3.0 μmol/L was defined to indicate toxic loads based on previous bone biopsy studies.
39 patients (34 anuric) were studied. Mean dose of Alucap was 3.5 capsules/d over 23.0 months. Pre-DFO Al levels were > 1.0 μmol/L in only 2 patients and none were > 3.0 μmol/L. No patients had a post DFO Al levels > 3.0 μmol/L. There were no correlations between the serum Al concentrations (pre-, post- or the incremental rise after DFO administration) and the total amount of Al ingested.No patients had unexplained EPO resistance or biochemical evidence of adynamic bone.
Although this is a small study, oral aluminium exposure was considerable. Yet no patients undergoing HD with RO treated water had evidence of Al toxicity despite doses equivalent to 3.5 capsules of Alucap for 2 years. The relationship between the DFO-Al results and the total amount of Al ingested was weak (R² = 0.07) and not statistically significant. In an era of financial prudence, and in view of the recognised risk of excess calcium loading in dialysis patients, perhaps we should re-evaluate the risk of using Al-based phosphate binders in HD patients who remain uric.
在 20 世纪 80 年代，当接受含铝磷酸盐结合剂（Alucaps）治疗且使用可能受到铝污染的水进行血液透析（HD）的患者摄入铝时，常发生铝毒性。本研究旨在确定仅接受反渗透（RO）处理的透析水治疗、且既往或当前暴露于 Alucaps 的 HD 患者发生铝毒性的风险。
对接受过 Alucaps 治疗但从未接触过受污染透析液的 HD 患者进行标准化地拉芬辛（DFO）检测。根据先前的骨活检研究，将 DFO 后血清铝水平>3.0 μmol/L 定义为有毒负荷。
共研究了 39 例患者（34 例无尿）。Alucap 的平均剂量为 3.5 片/天，持续 23.0 个月。仅 2 例患者的 DFO 前铝水平>1.0 μmol/L，且均未>3.0 μmol/L。没有患者的 DFO 后血清铝水平>3.0 μmol/L。血清铝浓度（DFO 前、后或 DFO 给药后增量）与摄入的总铝量之间无相关性。无患者出现不明原因的促红细胞生成素抵抗或无动力性骨的生化证据。
尽管本研究规模较小，但口服铝暴露量相当大。然而，在接受 RO 处理水的 HD 患者中，尽管接受了相当于 3.5 片 Alucap 持续 2 年的剂量，却没有证据表明存在铝毒性。DFO-Al 结果与摄入的总铝量之间的关系较弱（R²=0.07），且无统计学意义。在注重经济节约的时代，鉴于透析患者存在钙过量负荷的公认风险，我们或许应该重新评估在保持无尿的 HD 患者中使用基于铝的磷酸盐结合剂的风险。
