Aluminum load in chronic intermittent plasma exchange.

Aluminum (Al) loading due to administration of human albumin (HA) solutions was studied in 2 patients with stable renal function who underwent plasma exchange once (patient A) and twice (patient B) per week for treatment of hyperviscosity syndrome. Al was determined by Zeeman-AAS in plasma before, during and after treatment, also in bone of one patient and in various preparations of HA from different manufacturers. In addition, the net Al uptake (difference between total Al influx and efflux) and the 24th urinary excretion between 2 exchanges were determined. The electrolyte solution used for dilution had no detectable Al, while HA contained between 15 and 1900 micrograms Al/l. Increase of Al in plasma after treatment was clearly related to Al content of the HA used. When the patients received substitution solutions based on inadvertently highly Al contaminated 20% HA (1419 micrograms/l), the average net uptake was 2265 in patient A and 2049 micrograms in patient B and plasma Al rose from 8.4 respectively 18.0 before to 69.2 and 86.5 micrograms/l after treatment. By using medium Al contaminated HA (574 micrograms/l), the net uptake was 742 (pat. A) and 819 micrograms (pat.B), and there was an elevation of plasma Al from 5.1 respectively 18.2 to 34.2 and 39.8 micrograms/l. Following a net uptake of 870 micrograms patient A excreted 668 micrograms Al until the next treatment (23% positive balance). Treating patient A with a low Al HA (47 micrograms/l), there was a slight increase of plasma Al from 10.8 to 16.2 micrograms/l, the net Al uptake was negligible (less than 10 micrograms), and the weekly Al balance was negative. After 10 months of plasma exchange therapy (patient A) there was no increase of Al in bone (6.4 micrograms/g). We conclude, that the use of HA with a low Al contamination is recommended for all patients receiving this therapy during chronic intermittent plasma exchange or for other indications, especially in cases with impaired renal function.