Dialysis encephalopathy is a progressive neurological disease which usually causes death in six to eight months. Although primarily occurring in hemodialyzed uremic patients, it is being seen with increasing frequency in non-dialyzed uremic patients and patients on peritoneal dialysis. Based on strong biochemical and epidemiological data, aluminum has been implicated in the pathogenesis of this disease. Although the source of the aluminum loading was initially felt to be from aluminum-contaminated dialysate, it has more recently become apparent that aluminum loading can occur from the orally administered, aluminum-containing, phosphate-binding gels. In view of the known toxicity of aluminum, the minimum amount of aluminum-containing, phosphate-binding gels should be administered to control serum phosphorus levels, and alternate methods of phosphate control should be sought.
