Abstract
The plasma aluminum (Al) concentration before and after 2g of DFO administration (DFO test) was measured in 75 patients under maintenance hemodialysis to evaluate Al body accumulation and its relation to anemia. The average age of the patients was 47.9±13 (M±SD) years and the average length of maintenance hemodialysis was 7.4±3.5 years.
The difference between plasma Al levels before DFO infusion (Al1) and plasma Al levels just before the next hemodialysis (Al2) was defined as ΔAl, and was interpreted as an index of body Al accumulation. Al is measured by flameless atomic absorption spectrophotometry. The dialysate was made of the commercial bicarbonate dialysate preparations (Kindaly AF-IP) with water treated by reverse osmosis and deionization. Al concentration in dialysate was 1μg/l.
The mean plasma Al concentration in 75 patients was 36.0±19.0μg/l and mean ΔAl was 72.1±39.6mg/. There was a positive corrlation (r=0.44) between ΔAl and plasma Al concentration. No correration was observed between plasma Al concentration and Hb, Ht, red blood cell counts, MCV or MCH. ΔAl also showed no significant correlations with these parameters. There were positive correlations between ΔAl and the length of period on dialysis (r=0.50), and between ΔAl and cumulative total dose of aluminum hydroxide gels (r=0.51).
When ΔAl by DFO test were compared between DFO doses of 1g and 2g, there was a close correlation (r=0.79) between DFO doses. Thus the 1g dose of DFO was considered sufficient to evaluate body cumulation of Al.
The 21 cases with ΔAl over 100μg/l were treated with 1g of DFO once a week for 3 months. At the end of the first month of this treatment, plasma Al, ΔAl, Hb, Ht, and MCH improved significantly. By the end of 3 months of treatment, red blood cell counts increased significantly and serum PTH significantly decreased. Serum ferritin was unchanged throuthout the treatment period.
It appears that Al accumulation in responsible for the anemia in those patients under maintenance hemodialysis whose ΔAl was over 100μg/l.
