Canavese C, Thea A, Pacitti A, Salomone M, Mangiarotti G, Segoloni G, Stratta P, Gurioli L, Constantini S, Giordini R
Department of Nephrology, S. Giovanni-Molinette Hospital, University of Torino, Italy.
Clin Nephrol. 1989 Apr;31(4):169-74.
The authors evaluate the efficacy of a protocol of prevention and treatment of aluminum (Al) overload in RDT patients during a 7-year period (from 1981, 164 patients, to 1987, 161 patients). Al in dialysate solutions was always less than 25 micrograms/l. Baseline Al levels greater than 100 micrograms/l were found in 22% of patients in 1981 but in none in 1987, while the percentage of values less than 60 micrograms/l increased from 55 to 91%. DFO tests were positive in 54% and 7% of cases in 1981 and 1987, respectively. A clinical diagnosis of Al intoxication was performed in 6 patients in 1981, and no further cases were diagnosed later. DFO treatment (50 mg/kg once a week) was employed preventively in 31 patients owing to positive DFO-tests, and in the 6 Al-intoxicated patients therapeutically. In the former patients none developed clinical intoxication. In the latter group clinical improvement was only temporary in the three parathyroidectomized patients. Al hydroxide [Al(OH)3] as a phosphate binder was tapered off in 1981 and substituted by Al-free chelants. In 1987, 66% of patients were given CaCO3 or Mg (OH)2 alone or in association, while 34% still needed Al(OH)3, although at low dosages (less than 2 g/day). The conclusion is that such a protocol is able to prevent and to treat cases of Al intoxication, albeit only partially.
作者评估了一项在7年期间（从1981年的164例患者到1987年的161例患者）对接受规律透析治疗（RDT）患者预防和治疗铝（Al）过载方案的疗效。透析液中的铝含量始终低于25微克/升。1981年，22%的患者基线铝水平高于100微克/升，但1987年无一例出现这种情况，而低于60微克/升的比例从55%增加到了91%。去铁胺（DFO）试验在1981年和1987年的阳性率分别为54%和7%。1981年有6例患者被临床诊断为铝中毒，之后未再诊断出其他病例。由于DFO试验呈阳性，31例患者接受了预防性DFO治疗（每周一次，50毫克/千克），6例铝中毒患者接受了治疗性DFO治疗。在前者中，无人发生临床中毒。在后者中，3例甲状旁腺切除患者的临床改善只是暂时的。1981年逐渐停用氢氧化铝[Al(OH)3]作为磷结合剂，并代之以无铝螯合剂。1987年，66%的患者单独或联合使用碳酸钙（CaCO3）或氢氧化镁[Mg(OH)2]，而34%的患者仍需要Al(OH)3，尽管剂量较低（每天少于2克）。结论是，这样的方案能够预防和治疗铝中毒病例，尽管只是部分有效。
